Endovascular Treatment of Ruptured or Symptomatic Thoracoabdominal and Pararenal Aortic Aneurysms Using Octopus Endograft Technique: Mid-Term Clinical Outcomes

• Published in: Journal of endovascular therapy 2023-04, Vol.30 (2), p.163-175
• Main Authors: Wang, Mian, Yao, Chen, Yin, Hen-Hui, Wang, Jin-Song, Liao, Bing-Ye, Li, Zi-Lun, Wu, Ri-Dong, Peng, Gui-Yan, Chang, Guang-Qi
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aortic Aneurysm, Abdominal - complications; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - surgery; Aortic Aneurysm, Thoracic - complications; Aortic Aneurysm, Thoracic - diagnostic imaging; Aortic Aneurysm, Thoracic - surgery; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Endoleak - diagnostic imaging; Endoleak - etiology; Endoleak - surgery; Endovascular Procedures; Humans; Ischemia - surgery; Male; Middle Aged; Prosthesis Design; Retrospective Studies; Treatment Outcome
• ISSN: 1526-6028; 1545-1550
• DOI: 10.1177/15266028221075236

Objective: To evaluate the effectiveness and safety of using off-the-shelf “Octopus” technique to treat ruptured or symptomatic thoracoabdominal aortic aneurysm (TAAA) and pararenal abdominal aortic aneurysm (PRAAA). Methods and Results: All cases who underwent “Octopus” technique from May 2016 to May 2019 at our center were retrospectively analyzed. A total of 10 cases (8 males) were included. The mean age was 54.5±14.2 years (range: 31–80 years). Eight cases presented as aneurysm rupture or impending rupture accepted emergency repair. Technical success, defined by placement of all endografts as planned, was achieved in all cases. A total of 30 target visceral branches were successfully cannulated, 9 celiac arteries were covered intentionally. Intraoperative endoleak was observed in 6 patients, all of them were gutter leak. During hospital stay, there was no death, no side branch occlusion or spinal cord ischemia. Median follow-up was 30 months (range: 12–50 months). One patient died of lung cancer at 14-month follow-up. There was no secondary endoleak. The primary endoleak were found spontaneously resolved in 3 cases at 7 days, 3-month, and 1-year imaging. One persistent endoleak totally resolved after sealing of gutter spaces at 4-month follow-up. The other 2 persistent endoleak decreased during follow-up, which are still under observation. The branch patency rate was 90.3% (28/31). All the 3 occluded branches were renal arteries. Branch occlusion occurred in 2 cases at 1-month follow-up and 1 case at 2-year follow-up, but renal insufficiency was not observed in these cases. Obvious aneurysm sac shrinkage (≥5 mm) was observed in all cases. The aneurysm size shrunk from 7.6±1.9 to 5.5±1.4 cm. No spinal cord ischemia occurred during follow-up. Conclusion: Treatment of ruptured TAAA and PRAAA with “Octopus” technique is feasible and safe for high surgical risk patients in the absence of fenestrated and branched devices. The long-term clinical outcomes needed to be investigated.