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Long-term results of treatment of infrarenal aortic aneurysms with low-profile stent grafts in a multicenter registry.
de Donato, Gianmarco; Pasqui, Edoardo; Nano, Giovanni; Lenti, Massimo; Mangialardi, Nicola; Speziale, Francesco; Ferrari, Mauro; Michelagnoli, Stefano; Tozzi, Matteo; Palasciano, Giancarlo.
Afiliação
  • de Donato G; Department of Vascular Surgery, University of Siena, Siena, Italy. Electronic address: dedonato@unisi.it.
  • Pasqui E; Department of Vascular Surgery, University of Siena, Siena, Italy.
  • Nano G; Department of Vascular Surgery, IRCCS Policlinico San Donato, Milan, Italy.
  • Lenti M; Department of Vascular Surgery, University of Perugia, Perugia, Italy.
  • Mangialardi N; Department of Vascular Surgery, Ospedale San Camillo, Rome, Italy.
  • Speziale F; Department of Vascular Surgery, La Sapienza University of Rome, Rome, Italy.
  • Ferrari M; Department of Vascular Surgery, University of Pisa, Pisa, Italy.
  • Michelagnoli S; Department of Vascular Surgery, Ospedale San Giovanni di Dio, Florence, Italy.
  • Tozzi M; Department of Vascular Surgery, University of Insubria, Insubria, Italy.
  • Palasciano G; Department of Vascular Surgery, University of Siena, Siena, Italy.
J Vasc Surg ; 75(4): 1242-1252.e2, 2022 04.
Article em En | MEDLINE | ID: mdl-34634415
OBJECTIVE: In recent years, manufacturers have developed new stent grafts with lower profiles to increase the endovascular aneurysm repair applicability. As reported by the current European Society for Vascular Surgery guidelines, long-term evaluation of such low-profile platforms is strongly recommended. This study aims to report outcomes beyond 5 years from a multicenter registry, including a real-world cohort of patients electively treated with low-profile stent grafts. METHODS: A retrospective data collection of patients who had undergone elective implantation of low-profile endograft ≤16 Fr. (Zenith LP, Ovation, Incraft) was performed in nine centers. The primary endpoint was a long-term primary clinical success. Secondary endpoints were survival rate, freedom from abdominal aortic aneurysm (AAA)-related death, freedom from type I to III endoleak, limb patency, and freedom from all reinterventions. The Kaplan-Meier curves were stratified for investigative devices. A multivariate analysis evaluated predictors of primary clinical success and reintervention rate. RESULTS: A total of 619 patients were enrolled (Ovation, n = 373; Incraft, n = 111; and Zenith LP, n = 135), with a mean follow-up of 56.8 ± 22.8 months. The overall primary and the secondary clinical success rate at 8 years was 72.1% and 93.8%, respectively. At 8 years, overall survival was 53.2%, freedom from AAA-related death was 94.4%, freedom from reintervention was 74%, freedom from type I/III endoleak was 86.9%, and limb patency was 90.4%. A significantly worse primary clinical success of the Zenith LP was recorded as dependent on more limb-related events. No differences between platforms were registered in the rate of AAA-related deaths, open conversion, sac enlargement, and type I/III endoleaks (P = .26). Multivariate analysis identified iliac tortuosity (hazard ratio, 2.053) and Zenith LP (hazard ratio, 3.818) as significant independent predictors of clinical failure and reintervention. CONCLUSIONS: Low-profile stent grafts have acceptable long-term outcomes. Overall survival and AAA-related death were in line with those reported for traditional devices. Long-term surveillance and reintervention, when necessary, remain crucial to guarantee durability.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Aneurisma da Aorta Abdominal / Implante de Prótese Vascular / Procedimentos Endovasculares Tipo de estudo: Etiology_studies / Guideline / Observational_studies / Prognostic_studies Limite: Humans Idioma: En Ano de publicação: 2022 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Aneurisma da Aorta Abdominal / Implante de Prótese Vascular / Procedimentos Endovasculares Tipo de estudo: Etiology_studies / Guideline / Observational_studies / Prognostic_studies Limite: Humans Idioma: En Ano de publicação: 2022 Tipo de documento: Article