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Multicentre Experience with Novel Bidirectional Double Cuffed Inner Branches for Complex Endovascular Aortic Repair

Berczeli, Márton LU orcid ; Kölbel, Tilo ; Tsilimparis, Nikolaos ; Karelis, Angelos LU orcid ; Oderich, Gustavo S. ; Panuccio, Giuseppe ; Rohlffs, Fiona ; Sonesson, Björn LU and Dias, Nuno V. LU orcid (2024) In European journal of vascular and endovascular surgery
Abstract

Objective: This study aimed to report the initial experience with a novel bidirectional double cuff inner branch design for incorporation of renal and mesenteric arteries in patients undergoing fenestrated and branched endovascular aortic repair (F/BEVAR). Methods: A retrospective review was undertaken of the experience of F/BEVAR with grafts integrating at least one bidirectional double cuffed inner branch implanted at three tertiary aortic centres between March 2022 and June 2023. All consecutive patients were included. Baseline characteristics, operative data, and follow up data were collected. Results were presented as number or median (interquartile range) unless otherwise stated. Results: Thirteen patients (10 male; median age 72... (More)

Objective: This study aimed to report the initial experience with a novel bidirectional double cuff inner branch design for incorporation of renal and mesenteric arteries in patients undergoing fenestrated and branched endovascular aortic repair (F/BEVAR). Methods: A retrospective review was undertaken of the experience of F/BEVAR with grafts integrating at least one bidirectional double cuffed inner branch implanted at three tertiary aortic centres between March 2022 and June 2023. All consecutive patients were included. Baseline characteristics, operative data, and follow up data were collected. Results were presented as number or median (interquartile range) unless otherwise stated. Results: Thirteen patients (10 male; median age 72 [68, 77] years) had F/BEVAR using a total of 15 bidirectional double cuffed inner branches (30 cuffs). Indications for bidirectional doubled cuffed inner branches included cranial vessel orientation or double renal arteries in four patients each, common coeliomesenteric trunk in three patients, and early renal artery bifurcation, renal artery origin from a false lumen requiring a flexible route for catheterisation, and surplus configuration in one patient each. Twenty three of the 30 cuffs were used, whereas the remaining seven cuffs were intentionally occluded with vascular plugs. Target vessel incorporation was successful in all bidirectional branches. There was one technical failure related to unsuccessful catheterisation of a left renal artery targeted through a unidirectional caudal inner branch. During a median follow up of seven months there were no instances of target vessel instability or re-interventions and two patients died of causes unrelated to the bidirectional branches. Conclusion: The results of the use of bidirectional double cuff inner branches are promising, with high technical success and no short term branch related complications in this preliminary experience. This could potentially expand the applicability of branch endografting of complex endovascular aortic repairs, but long term results are still missing.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
in press
subject
keywords
Aortic aneurysm, BEVAR, Bidirectional branch, Branched endovascular aortic repair, Complex endovascular aortic repair, Inner branch
in
European journal of vascular and endovascular surgery
publisher
Elsevier
external identifiers
  • pmid:38705454
  • scopus:85193071778
ISSN
1078-5884
DOI
10.1016/j.ejvs.2024.04.040
language
English
LU publication?
yes
id
e9a67688-edb6-4061-8261-5c37ca3f5a85
date added to LUP
2024-05-23 15:42:00
date last changed
2024-06-20 21:17:17
@article{e9a67688-edb6-4061-8261-5c37ca3f5a85,
  abstract     = {{<p>Objective: This study aimed to report the initial experience with a novel bidirectional double cuff inner branch design for incorporation of renal and mesenteric arteries in patients undergoing fenestrated and branched endovascular aortic repair (F/BEVAR). Methods: A retrospective review was undertaken of the experience of F/BEVAR with grafts integrating at least one bidirectional double cuffed inner branch implanted at three tertiary aortic centres between March 2022 and June 2023. All consecutive patients were included. Baseline characteristics, operative data, and follow up data were collected. Results were presented as number or median (interquartile range) unless otherwise stated. Results: Thirteen patients (10 male; median age 72 [68, 77] years) had F/BEVAR using a total of 15 bidirectional double cuffed inner branches (30 cuffs). Indications for bidirectional doubled cuffed inner branches included cranial vessel orientation or double renal arteries in four patients each, common coeliomesenteric trunk in three patients, and early renal artery bifurcation, renal artery origin from a false lumen requiring a flexible route for catheterisation, and surplus configuration in one patient each. Twenty three of the 30 cuffs were used, whereas the remaining seven cuffs were intentionally occluded with vascular plugs. Target vessel incorporation was successful in all bidirectional branches. There was one technical failure related to unsuccessful catheterisation of a left renal artery targeted through a unidirectional caudal inner branch. During a median follow up of seven months there were no instances of target vessel instability or re-interventions and two patients died of causes unrelated to the bidirectional branches. Conclusion: The results of the use of bidirectional double cuff inner branches are promising, with high technical success and no short term branch related complications in this preliminary experience. This could potentially expand the applicability of branch endografting of complex endovascular aortic repairs, but long term results are still missing.</p>}},
  author       = {{Berczeli, Márton and Kölbel, Tilo and Tsilimparis, Nikolaos and Karelis, Angelos and Oderich, Gustavo S. and Panuccio, Giuseppe and Rohlffs, Fiona and Sonesson, Björn and Dias, Nuno V.}},
  issn         = {{1078-5884}},
  keywords     = {{Aortic aneurysm; BEVAR; Bidirectional branch; Branched endovascular aortic repair; Complex endovascular aortic repair; Inner branch}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{European journal of vascular and endovascular surgery}},
  title        = {{Multicentre Experience with Novel Bidirectional Double Cuffed Inner Branches for Complex Endovascular Aortic Repair}},
  url          = {{http://dx.doi.org/10.1016/j.ejvs.2024.04.040}},
  doi          = {{10.1016/j.ejvs.2024.04.040}},
  year         = {{2024}},
}