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Distal landing zone outcomes in thoracic endovascular aortic aneurysm repair with challenging morphology : a propensity-matched comparison of distal active fixation versus standard stent-graft

Gennai, Stefano ; Leone, Nicola ; Karelis, Angelos LU orcid ; Xodo, Andrea ; Mezzetto, Luca ; Fargion, Aaron ; Antonello, Michele ; Veraldi, Gian Franco ; Dias, Nuno V LU orcid and Sonesson, Björn LU , et al. (2022) In International Angiology 41(1). p.24-32
Abstract

BACKGROUND: To evaluate the distal landing zone (LZ) outcomes in adverse morphology after thoracic endovascular repair (TEVAR) with distal active fixation (DAF) stent-grafts compared with standard endografts.

METHODS: between 2006 and the 31st December 2020, sixty-nine DAFs (study group) and sixty-nine standard stent-grafts (control group) were enrolled in a multi-center, retrospective, case-control study. The primary outcomes were the distal endoleak and reintervention. The secondary outcomes were: distal segment migration, wedge apposition and related complications. A univariate and multivariate logistic regression followed by a propensity-scored model (1:1) were performed.

RESULTS: The results were reported for the DAF vs... (More)

BACKGROUND: To evaluate the distal landing zone (LZ) outcomes in adverse morphology after thoracic endovascular repair (TEVAR) with distal active fixation (DAF) stent-grafts compared with standard endografts.

METHODS: between 2006 and the 31st December 2020, sixty-nine DAFs (study group) and sixty-nine standard stent-grafts (control group) were enrolled in a multi-center, retrospective, case-control study. The primary outcomes were the distal endoleak and reintervention. The secondary outcomes were: distal segment migration, wedge apposition and related complications. A univariate and multivariate logistic regression followed by a propensity-scored model (1:1) were performed.

RESULTS: The results were reported for the DAF vs control group. The mean follow-up was 3.3 ± 2.1 vs 3.7 ± 3.4 years. The distal endoleak rate was 7.3% vs 27.5% (P=0.011). The freedom from distal endoleak was 95%, 95% and 91% vs 85%, 76%, and 73% at 1, 3 and 5 years respectively (Log-rank P=0.011). Tortuosity index and distal thoracic aorta angulation were predictors of endoleak (P=0.012 and P=0.029 respectively). The distal reinterventions rate was 7.3% vs 20.3% (P=0.026). The freedom from distal reinterventions was 95%, 95% and 91% vs 92%, 75% and 75% at 1, 3 and 5 years respectively (Log-rank P=0.041). The wedge apposition was 5.8 vs 13.0-mm (P<0.000). The distal segment migration was upward directed in all cases and was significant (>10- mm) in 13.0% vs 39.1% (P=0.000).

CONCLUSIONS: The DAF stent-graft showed a significant reduction of the distal endoleak rates and other specific outcomes of the distal LZ in patients with an adverse anatomy.

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publishing date
type
Contribution to journal
publication status
published
subject
in
International Angiology
volume
41
issue
1
pages
24 - 32
publisher
Minerva Medica
external identifiers
  • scopus:85125016027
  • pmid:34636507
ISSN
1827-1839
DOI
10.23736/S0392-9590.21.04718-0
language
English
LU publication?
no
id
4704831c-907f-4561-ab83-19ee4fe4a5f0
date added to LUP
2021-10-20 10:48:49
date last changed
2024-11-07 16:13:01
@article{4704831c-907f-4561-ab83-19ee4fe4a5f0,
  abstract     = {{<p>BACKGROUND: To evaluate the distal landing zone (LZ) outcomes in adverse morphology after thoracic endovascular repair (TEVAR) with distal active fixation (DAF) stent-grafts compared with standard endografts.</p><p>METHODS: between 2006 and the 31st December 2020, sixty-nine DAFs (study group) and sixty-nine standard stent-grafts (control group) were enrolled in a multi-center, retrospective, case-control study. The primary outcomes were the distal endoleak and reintervention. The secondary outcomes were: distal segment migration, wedge apposition and related complications. A univariate and multivariate logistic regression followed by a propensity-scored model (1:1) were performed.</p><p>RESULTS: The results were reported for the DAF vs control group. The mean follow-up was 3.3 ± 2.1 vs 3.7 ± 3.4 years. The distal endoleak rate was 7.3% vs 27.5% (P=0.011). The freedom from distal endoleak was 95%, 95% and 91% vs 85%, 76%, and 73% at 1, 3 and 5 years respectively (Log-rank P=0.011). Tortuosity index and distal thoracic aorta angulation were predictors of endoleak (P=0.012 and P=0.029 respectively). The distal reinterventions rate was 7.3% vs 20.3% (P=0.026). The freedom from distal reinterventions was 95%, 95% and 91% vs 92%, 75% and 75% at 1, 3 and 5 years respectively (Log-rank P=0.041). The wedge apposition was 5.8 vs 13.0-mm (P&lt;0.000). The distal segment migration was upward directed in all cases and was significant (&gt;10- mm) in 13.0% vs 39.1% (P=0.000).</p><p>CONCLUSIONS: The DAF stent-graft showed a significant reduction of the distal endoleak rates and other specific outcomes of the distal LZ in patients with an adverse anatomy.</p>}},
  author       = {{Gennai, Stefano and Leone, Nicola and Karelis, Angelos and Xodo, Andrea and Mezzetto, Luca and Fargion, Aaron and Antonello, Michele and Veraldi, Gian Franco and Dias, Nuno V and Sonesson, Björn and Pratesi, Carlo and Silingardi, Roberto}},
  issn         = {{1827-1839}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{24--32}},
  publisher    = {{Minerva Medica}},
  series       = {{International Angiology}},
  title        = {{Distal landing zone outcomes in thoracic endovascular aortic aneurysm repair with challenging morphology : a propensity-matched comparison of distal active fixation versus standard stent-graft}},
  url          = {{http://dx.doi.org/10.23736/S0392-9590.21.04718-0}},
  doi          = {{10.23736/S0392-9590.21.04718-0}},
  volume       = {{41}},
  year         = {{2022}},
}