Editor's Choice - Long Term Outcomes of the Advanta V12 Covered Bridging Stent for Fenestrated and Branched Endovascular Aneurysm Repair in 1 675 Target Vessels.

OBJECTIVE: To report outcomes of the Advanta V12 as a covered bridging stent in fenestrated and branched endovascular aneurysm repair (F/BEVAR). METHODS: Patients treated with F/BEVAR and followed in a single centre receiving the Advanta V12 as a covered bridging stent between January 2010 and May 2020 were included. RESULTS: A total of 636 patients (543 men) were analysed. A total of 1 675 target vessels (TVs) were bridged with the Advanta V12. Estimated TV patency at one, five, and eight years was 99.1% ± 0.2%, 96.9% ± 0.5% and 96.2% ± 0.7%, respectively. Estimated patency at eight years was 98.1% ± 0.5% for fenestrations and 87.3% ± 2.9% for branches (p < .001). Estimated patency of renal arteries was statistically significantly lower for those targeted with branches compared with fenestrations (p = .001). Multivariable analysis showed that targeting a TV with a branch compared with a fenestration was the only independent risk factor for occlusion during follow up (hazard ratio 6.41, 95% CI 3.4 - 11.9; p < .001). Estimated freedom from endoleak at one, five, and eight years was 99.4% ± 0.2%, 96.4% ± 0.6%, and 95.4% ± 0.8%, respectively. Estimated freedom from target vessel instability (TVI) at one, five, and eight years was 98.5% ± 0.3%, 93.0% ± 0.8%, and 91.3% ± 1%, respectively. Estimated freedom from TVI at eight years was 93.2% ± 0.9% for fenestrations and 82.7% ± 3.5% for branches (p < .001). Estimated freedom from TVI was statistically significantly lower for renal arteries targeted with branches compared with those targeted with fenestrations (p < .001) CONCLUSION: The Advanta V12 shows excellent technical success rates as a covered bridging stent in F/ΒEVAR. Late outcomes remain good with low rates of TV occlusion, endoleak, and re-intervention. Renal arteries targeted with branches demonstrated a higher risk of occlusion and instability compared with those targeted with fenestrations.

Mid-Term Results of Fenestrated Endovascular Repair after Prior Open Aortic Reconstruction.

This study aims to assess the mid-term results of fenestrated endovascular aneurysm repair (FEVAR) for the treatment of proximal aortic pathology after previous open surgical repair (OSR). All patients with a previous history of OSR of an abdominal aortic aneurysm undergoing a FEVAR procedure between October 2010 and November 2021 were included. The endpoints of the study were technical success, mortality, target vessel patency and reinterventions during follow-up. Thirty-five patients (34 male, mean age 72.9 ± 7 years) were included. The median interval from the primary surgery to the FEVAR procedure was 136 months (range 47-261). The indication for treatment was a para-anastomotic aneurysm in 18 (51%) patients and a true aneurysm due to progression of disease in 17 (49%) patients. Technical success was achieved in 33 (94%) patients. There was one (3%) early death due to postoperative bleeding from a renal artery. Estimated survival at 12, 24 and 36 months was 89.1% ± 6%, 84.4% ± 7.3% and 84.4% ± 7.3%, respectively. There was no aneurysm-related mortality. One (3%) target vessel occluded during follow-up and three (9%) patients underwent late reinterventions. In conclusion, FEVAR is a safe and effective alternative for the endovascular treatment of para-anastomotic aneurysms/pseudoaneurysms after OSR showing high technical success, low mortality and morbidity, and good mid-term outcomes.

Fenestrated and branched stent grafts for the treatment of post-dissection thoracoabdominal aortic aneurysms.

The present study aims to analyze fenestrated/branched endovascular aneurysm repair (F/BEVAR) in the treatment of post-dissection thoracoabdominal aortic aneurysms (PD-TAAAs). Focus is given on indication, anatomic suitability, device planning, and clinical outcomes. PD-TAAAs present with additional challenges in F/BEVAR. These include true lumen compression and visceral arteries originating from the false lumen. These technical challenges limited the use of F/BEVAR in PD-TAAAs to a few institutions in the beginning, but the good results reported with this approach have led to an increase in its use in a growing number of centers. Our current single-center experience includes 75 patients treated with F/BEVAR for a PD-TAAA between October 2010 and October 2021. Technical success was achieved in 74 cases (98.7%). Two patients (2.6%) died in the first 30 postoperative days. Ten patients (13.3%) had postoperative symptoms of spinal cord ischemia: 9 (12%) with transient limb weakness and 1 (1.3%) with permanent paraplegia. There was only 1 death (1.3%) related to the aneurysm during follow-up. Mean ± SD estimated primary patency rates of the target vessels at 12, 24, and 36 months were 97.9% ± 1%, 96.1% ± 1.6%, and 95.2% ± 1.9%, respectively. The estimated freedom from re-intervention rates at these time points were 81.4% ± 5.3%, 56.9% ± 7.3%, and 53.9% ± 7.5%, respectively. In conclusion, F/BEVAR can be performed in PD-TAAAs with high rates of technical success and good mid-term results with regard to mortality and morbidity. The additional technical challenges posed by PD-TAAAs need to be considered to prevent complications and decrease the high rate of re-interventions.