Contemporary Experience of the Neo-Aortoiliac System (NAIS) Procedure: A Case Series with Review of the Literature.

OBJECTIVES: Aortic graft infection (AGI) is a life-threatening complication that can result in death, amputation, sepsis, aorto-enteric fistula, and pseudoaneurysm formation. After explantation of the infected graft, options for reconstruction include extra-anatomic bypass or in-line reconstruction using antibiotic-coated prosthetic graft, cryopreserved allograft, or a neo-aortoiliac system (NAIS) using autogenous femoral veins. While the NAIS procedure has shown promising results, there is relatively limited clinical experience due the magnitude and morbidity of the surgery. In this study, we reviewed our single-center experience using the NAIS procedure and performed a systematic review of the contemporary literature more than the past decade. METHODS: A retrospective review was performed on all patients undergoing NAIS reconstruction with autogenous femoral vein conduits at a single institution from 2010 to 2022. Pubmed, Embase, and Cochrane Library databases were queried for studies published from 2012 to 2022 to identify those reporting on outcomes of patients undergoing the NAIS procedure. Outcome variables included early and late mortality, major complications including amputation, graft or conduit related complications, re-infection, and re-intervention. Additional variables collected include patient demographics, operative technique, and follow up. RESULTS: There were 14 patients included in our case series with 30-day mortality of 21%. At a mean follow up of 22 months, complication rate was 64.3%, re-intervention rate was 14.3%, re-infection rate was 7.1%, and amputation rate was 7.1%. On review of the literature, 12 studies ultimately met criteria to be included in analysis with a combined total of 368 patients. Pooled averages included 30-day mortality of 9.0%, re-intervention rate of 20.5%, re-infection rate of 5.6%, and amputation rate of 6.5%. CONCLUSIONS: The NAIS procedure for management of AGI is a formidable procedure with significant early mortality and morbidity. This treatment should be considered in the context of other revascularization options for management of an AGI.

A Hybrid Approach in the Management of a Large Pancreaticoduodenal Artery Aneurysm.

Pancreaticoduodenal artery aneurysms (PDAA) are rare and represent a small fraction of known visceral aneurysms. We describe a case of a 79-year-old male with an 82 mm PDAA in the setting of chronic celiac artery occlusion. The patient was treated with an open repair. Due to the large size of the aneurysm and the dense adhesions to the surrounding tissues, vascular control of the superior mesenteric artery (SMA) was achieved by endovascular balloon occlusion and the aneurysm repaired with resection and primary aneurysmorrhaphy. The patient had an uneventful postoperative course.

Total endovascular aortic arch repair using the Terumo Aortic triple-branch arch endograft.

OBJECTIVE: To evaluate the feasibility and outcomes of total endovascular repair of aortic arch aneurysms using a novel triple-branch arch endograft. METHODS: Retrospective review of the clinical data and outcomes of 3 patients with arch aneurysms treated at a single institution using a custom-made triple-branch aortic endograft (Terumo Aortic, Sunrise, FL) between 2015 and 2020. The device has 3 internal branches corresponding to the principal branches of the standard aortic arch, obviating the need for any surgical revascularization. This initial experience represents the first three cases ever performed in the world using this endograft. RESULTS: All procedures were technically successful. There were no strokes, in-hospital, or 1 year mortality. All 3 patients required secondary re-interventions. One patient died 14 months after the index procedure due to endocarditis unrelated to the arch repair. CONCLUSION: The initial experience with the Terumo Aortic triple-branch endograft for treatment aortic arch aneurysms showed that, while the procedure is technically feasible, there remain significant anatomic and mechanical challenges in the endovascular repair of this segment of the thoracic aorta. Further refinements of endograft design and identification of optimal bridging stent technology are needed.

Branched endograft repair of an aortic stump aneurysm.

We present a patient with an aortic stump aneurysm that was repaired with a custom-made, four-branched thoracoabdominal endograft. The repair was performed in two stages using a special delivery system designed to be introduced in an antegrade manner through a median sternotomy due to a lack of iliofemoral access. At 1 year, the patient remains in good health, with his aneurysm completely excluded and decreased in size, without migration, and all branch vessels patent. This report represents a unique endovascular repair of a complex aortic pathology in a patient without other surgical options.