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Multicentric Use of Commercially Available Infrarenal Endografts During Fenestrated Endovascular Aortic Repair : A Feasibility Study

Karelis, Angelos LU orcid ; Jonsson, Magnus ; Budtz-Lilly, Jacob ; Jirström, Wendela LU ; Sonesson, Björn LU and Dias, Nuno V. LU orcid (2024) In Journal of Endovascular Therapy
Abstract

Purpose: This study aimed to assess the feasibility and short-term outcomes of different manufactured proximal and distal stent graft components during fenestrated endovascular aortic repair (FEVAR). Materials and methods: A multicenter retrospective review was conducted at 3 aortic centers, involving all consecutive patients who underwent FEVAR utilizing a customized Dacron-based tubular proximal and a distal bifurcated polytetrafluoreten (PTFE)-based commercially available stent grafts. Primary outcomes were 30 day mortality, major adverse events, and technical and clinical success. Secondary outcomes assessed stent graft migration, occurrence of types I/III endoleak, and reintervention. Results: A total of 23 FEVAR cases across all... (More)

Purpose: This study aimed to assess the feasibility and short-term outcomes of different manufactured proximal and distal stent graft components during fenestrated endovascular aortic repair (FEVAR). Materials and methods: A multicenter retrospective review was conducted at 3 aortic centers, involving all consecutive patients who underwent FEVAR utilizing a customized Dacron-based tubular proximal and a distal bifurcated polytetrafluoreten (PTFE)-based commercially available stent grafts. Primary outcomes were 30 day mortality, major adverse events, and technical and clinical success. Secondary outcomes assessed stent graft migration, occurrence of types I/III endoleak, and reintervention. Results: A total of 23 FEVAR cases across all centers were included in this study. Technical success was achieved in all cases, with a median procedure time of 183 (153–244) minutes. There were no major adverse events, except for 1 transient acute renal failure. The median follow-up period was 23 (17–28) months. All target vessels retained patent with the exception of 1 right renal fenestration that showed signs of kinking at the first follow-up, and despite secondary intervention with relining and distal extension, there was an occlusion afterward and 1 hepatic artery with a separate fenestration. This and 1 successful relining of a superior mesenteric artery kink were the only reinterventions in this cohort. One case of persistent type 1b endoleak was reported in a patient with chronic type B aortic dissection, which resolved with distal extension on the external iliac artery 5 months after the index procedure. No deaths occurred throughout the follow-up with, and there were no signs of stent graft migration or type 3 endoleak. Conclusion: The use of commercially available PTFE-based bifurcated stent grafts to extend distally the tubular graft appears to be a feasible approach during FEVAR, with promising short-term outcomes. Further studies are necessary to define the applicability of this solution and evaluate long-term outcomes. Clinical Impact: This multicentric study on fenestrated endovascular aortic repair (FEVAR) demonstrates the feasibility and good short-term outcomes of utilizing a PTFE-based commercially available stent graft to extend the proximal tubular custom-made fenestrated stent graft. The high technical success rate, absence of major adverse events, and low occurrence of complications such as stent graft migration and endoleaks highlight the potential clinical benefits of this approach with an off-the-shelf distal extension whose delivery system does not cross the fenestrations intraoperatively.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
abdominal aortic aneurysm, endoleak, endovascular aneurysm repair, FEVAR, stent graft migration
in
Journal of Endovascular Therapy
publisher
International Society of Endovascular Specialists
external identifiers
  • pmid:38807416
  • scopus:85194898943
ISSN
1526-6028
DOI
10.1177/15266028241257090
language
English
LU publication?
yes
id
0a86d024-2b3e-418c-8d44-3f2eec2c2b8f
date added to LUP
2024-10-14 14:36:58
date last changed
2025-07-08 13:11:24
@article{0a86d024-2b3e-418c-8d44-3f2eec2c2b8f,
  abstract     = {{<p>Purpose: This study aimed to assess the feasibility and short-term outcomes of different manufactured proximal and distal stent graft components during fenestrated endovascular aortic repair (FEVAR). Materials and methods: A multicenter retrospective review was conducted at 3 aortic centers, involving all consecutive patients who underwent FEVAR utilizing a customized Dacron-based tubular proximal and a distal bifurcated polytetrafluoreten (PTFE)-based commercially available stent grafts. Primary outcomes were 30 day mortality, major adverse events, and technical and clinical success. Secondary outcomes assessed stent graft migration, occurrence of types I/III endoleak, and reintervention. Results: A total of 23 FEVAR cases across all centers were included in this study. Technical success was achieved in all cases, with a median procedure time of 183 (153–244) minutes. There were no major adverse events, except for 1 transient acute renal failure. The median follow-up period was 23 (17–28) months. All target vessels retained patent with the exception of 1 right renal fenestration that showed signs of kinking at the first follow-up, and despite secondary intervention with relining and distal extension, there was an occlusion afterward and 1 hepatic artery with a separate fenestration. This and 1 successful relining of a superior mesenteric artery kink were the only reinterventions in this cohort. One case of persistent type 1b endoleak was reported in a patient with chronic type B aortic dissection, which resolved with distal extension on the external iliac artery 5 months after the index procedure. No deaths occurred throughout the follow-up with, and there were no signs of stent graft migration or type 3 endoleak. Conclusion: The use of commercially available PTFE-based bifurcated stent grafts to extend distally the tubular graft appears to be a feasible approach during FEVAR, with promising short-term outcomes. Further studies are necessary to define the applicability of this solution and evaluate long-term outcomes. Clinical Impact: This multicentric study on fenestrated endovascular aortic repair (FEVAR) demonstrates the feasibility and good short-term outcomes of utilizing a PTFE-based commercially available stent graft to extend the proximal tubular custom-made fenestrated stent graft. The high technical success rate, absence of major adverse events, and low occurrence of complications such as stent graft migration and endoleaks highlight the potential clinical benefits of this approach with an off-the-shelf distal extension whose delivery system does not cross the fenestrations intraoperatively.</p>}},
  author       = {{Karelis, Angelos and Jonsson, Magnus and Budtz-Lilly, Jacob and Jirström, Wendela and Sonesson, Björn and Dias, Nuno V.}},
  issn         = {{1526-6028}},
  keywords     = {{abdominal aortic aneurysm; endoleak; endovascular aneurysm repair; FEVAR; stent graft migration}},
  language     = {{eng}},
  publisher    = {{International Society of Endovascular Specialists}},
  series       = {{Journal of Endovascular Therapy}},
  title        = {{Multicentric Use of Commercially Available Infrarenal Endografts During Fenestrated Endovascular Aortic Repair : A Feasibility Study}},
  url          = {{http://dx.doi.org/10.1177/15266028241257090}},
  doi          = {{10.1177/15266028241257090}},
  year         = {{2024}},
}