Endovascular repair of acute juxtarenal and thoracoabdominal aortic aneurysms with surgeon-modified fenestrated endografts.

Juszczak, Maciej T and Vezzosi, Massimo and Khan, Mashuk and Mascaro, Jorge and Claridge, Martin and Adam, Donald (2019) Endovascular repair of acute juxtarenal and thoracoabdominal aortic aneurysms with surgeon-modified fenestrated endografts. Journal of vascular surgery. ISSN 1097-6809. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using your UHB Athens login IDs.

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Official URL: https://www.jvascsurg.org/article/S0741-5214(19)32...

Abstract

OBJECTIVE

The objective of this study was to report the short- and medium-term outcome of surgeon-modified fenestrated endovascular aneurysm repair (SM-FEVAR) for acute complex aortic aneurysms.

METHODS

Interrogation of a prospectively maintained database identified consecutive patients who underwent SM-FEVAR for acute complex aortic aneurysms (including mycotic aneurysms treated with rifampicin-soaked endografts) in a single institution between October 2009 and November 2018.

RESULTS

A total of 54 patients (37 men; median age, 73 years [range, 50-85 years]; aneurysm diameter, 76 mm [interquartile range, 58-90 mm]) with acute thoracoabdominal aortic aneurysms (n = 50; 40 symptomatic, 10 ruptured; 19 extent I-III, 31 extent IV) or symptomatic type IA endoleaks after infrarenal endovascular aneurysm repair (n = 4) underwent SM-FEVAR. Seven of the patients had adjunct chimney and periscope stent grafts or surgical bypasses. A total of 187 vessels (mean, 3.4 [range, 1-5] per patient) were targeted for preservation; nine occluded intraoperatively or within 30 days. The 30-day/in-hospital mortality was 16.7% (n = 9; symptomatic, 7.4%; rupture, 50%) and fell significantly from 29.6% (n = 8) in the first 27 patients to 3.7% (n = 1) in the most recent 27 patients (P = .0243). Spinal cord ischemia occurred in one patient (1.9%) who died within 30 days. No survivors required permanent renal dialysis. Estimated survival at 12 and 24 months was 73.2% (standard error [SE], 6.2%). Eight patients underwent 12 late aorta- or graft-related reinterventions. Estimated freedom from reintervention at 12 months and 24 months was 87.9% (SE, 5.2%) and 81.6% (SE, 6.4%), respectively.

CONCLUSIONS

In patients with acute complex aneurysms, SM-FEVAR provides a customized solution that is associated with good medium-term survival and durability. The knowledge and skills to perform safe SM-FEVAR should be within the capabilities of high-volume specialist aortic centers.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using your UHB Athens login IDs.
Subjects: WO Surgery
Divisions: Planned IP Care > Vascular
Related URLs:
Depositing User: Mr Muneeb Liaquat
Date Deposited: 03 Jan 2020 14:38
Last Modified: 03 Jan 2020 14:38
URI: http://www.repository.uhblibrary.co.uk/id/eprint/2733

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