Mid-term outcomes of the use of endoanchors during thoracic endovascular aortic repair in multicentre analysis.

OBJECTIVE: To describe mid-term outcomes of the use of EndoAnchors as an adjunct for arch and thoracic endovascular aortic repair (TEVAR). METHODS: A retrospective multicentre series from nine centres using the Heli-FX EndoAnchor System (Medtronic Inc, Minneapolis, USA) at TEVAR over May 2014-May 2019 is presented. The study is registered at ClinicalTrials.gov with number NCT04100499. The primary outcome was freedom from Type I endoleak at EndoAnchors deployments; secondary outcomes included evaluation of aortic wall penetration (AWP) at first computed tomography scan, EndoAnchor-related issues and mortality. RESULTS: 54 high-risk patients (35 males/19 females, age 73 ± 11 years) with arch, thoracic and thoracoabdominal aneurysmal disease (3 chronic post-dissection and one patch pseudoaneurysm), with a mean neck length 19.7 ± 6.6 mm that were treated with multiple hybrid and endovascular techniques were included. A total of 329 EndoAnchors were used with a mean of 6.1 ± 2.5 per patient. Overall adequate AWP was 86%, whereas arch (Ishimaru's zones 0-2) deployments achieved 80.6% when compared to 87.3% in descending thoracic aorta (dTA); although there was no statistical significance. Freedom from type I endoleaks was 88% at 2 year follow-up, due to 4 type IA endoleaks, two of them successfully treated, one with conservative treatment due to complexity of repair and remaining patient died 1 year later due to endograft infection. There were reported five EndoAnchor-related issues; four losses and one renal stent-graft was crushed due to catheter deflection solved with balloon reinflation. None of the losses had clinical significance. Overall mortality is described for 7 (9.5%) patients, one of them aneurysm-related. CONCLUSIONS: The adjunctive use of EndoAnchors in TEVAR and complex TEVAR procedures achieved acceptable outcomes at midterm in a high-risk series with hostile seal zones. Still, they should be still judiciously used as there is lack of data to suggest a more liberal use; therefore, the landing zone should not be compromised in favour of their use.

Impact of the Aortic Graft on Arterial Stiffness and Inflammatory Biomarkers after Endovascular Aortic Repair or Open Surgical Repair in Abdominal Aortic Aneurysm Disease.

BACKGROUND: Abdominal aortic aneurysm (AAA) is an important cardiovascular (CV)-related disease that requires surgical treatment to prevent rupture. The elevation of arterial stiffness (AS) is an increasingly recognized independent determinant of CV morbidity and mortality and plays a special role in atherosclerosis. The importance of the surgical technique used for AAA repair in the long-term outcomes still needs to be clarified, and whether endovascular aortic repair (EVAR) or open surgical repair (OSR) confers high AS measurements and thus worse prognosis in terms of CV morbidity needs further investigation. METHODS: A prospective nonrandomized study that included consecutive patients requiring either EVAR or OSR for AAA disease between February 2015 and January 2016 was conducted. This study is registered on the National Institutes of Health website (ClinicalTrials.gov) and identified with NCT02642952. Several noninvasive measurements of AS and central aortic hemodynamics were obtained before surgery and in the first postoperative control (4-6 weeks), with change from baseline in heart rate-adjusted augmentation index (AIx@75) as main outcome. Likewise, inflammatory circulating biomarkers were also measured in the same time line. RESULTS: We included 44 patients, 25 in the EVAR group and 19 in the OSR group. Subjects who underwent EVAR were older and presented larger aneurysm diameter at baseline. There was a significant decrease in AIx@75 in the EVAR group after treatment (-4.1 ± 8.1%, P = 0.018), for a moderate effect size (d = 0.508), whereas the decreasing trend in the OSR group (-2.5 ± 6.7%, P = 0.127) was not statistically significant. No significant changes in carotid-radial pulse wave velocity (PWVCR) and central blood pressures were observed. The inflammatory markers increased after surgical repair, with significant changes in homocysteine in both EVAR (5.2 ± 6.9 µmol/L, P = 0.002) and OSR (1.8 ± 2.1 µmol/L, P = 0.002) groups. CONCLUSIONS: Our study suggests that both treatments confer better postoperative values of AS measured by AIx@75 and produces no changes in PWVCR, in the early term. Whether this situation is maintained during follow-up needs further investigation.

Treatment of aberrant right subclavian artery aneurysm with endovascular exclusion and adjunctive surgical bypass.

Aberrant right subclavian arteries occur in as much as 2% of the population. Aneurysms in this vessel are rare but exhibit a marked propensity toward rupture; therefore, early elective treatment is indicated. Transluminally placed stent-grafts offer an alternative approach to the standard surgical treatment. This type of procedure is less invasive, with less attendant risk than operative repair. Because there was no proximal neck between the aneurysm and Kommerell diverticulum in the case described herein, it was decided to perform endovascular exclusion of the aneurysm by inserting an endoprosthesis to occlude the aortic exit of the aneurysm, combined with distal ligation. A bilateral carotid/subclavian bypass was also created to preserve the function of both subclavian arteries.