Fenestrated and Branched Endografts for Post-Dissection Thoraco-Abdominal Aneurysms: Results of a National Multicentre Study and Literature Review

• Published in: European journal of vascular and endovascular surgery 2022-12, Vol.64 (6), p.630-638
• Main Authors: Gallitto, Enrico, Faggioli, Gianluca, Melissano, Germano, Fargion, Aaron, Isernia, Giacomo, Bertoglio, Luca, Simonte, Gioele, Lenti, Massimo, Pratesi, Carlo, Chiesa, Roberto, Gargiulo, Mauro, Luca, Bertoglio, Roberto, Chiesa, Gianluca, Faggioli, Aaron, Fargion, Cecilia, Fenelli, Enrico, Gallitto, Mauro, Gargiulo, Giacomo, Isernia, Massimo, Lenti, Antonino, Logiacco, Chiara, Mascoli, Germano, Melissano, Rodolfo, Pini, Carlo, Pratesi, Andrea, Kahlberg, Gioele, Simonte, Paolo, Spath, Sara, Speziali
• Format: Article
• Language: English
• Subjects: Aneurysm - surgery; Aortic Aneurysm, Thoracic - diagnostic imaging; Aortic Aneurysm, Thoracic - surgery; Aortic dissection; Aortic remodelling; Blood Vessel Prosthesis - adverse effects; Blood Vessel Prosthesis Implantation - adverse effects; Endovascular Procedures - adverse effects; Fenestrated and branched endograft; Humans; Multicenter Studies as Topic; Post-dissection thoraco-abdominal aneurysm; Prosthesis Design; Retrospective Studies; Risk Factors; Spinal Cord Ischemia - surgery; Thoraco-abdominal aneurysm; Treatment Outcome
• ISSN: 1078-5884; 1532-2165
• DOI: 10.1016/j.ejvs.2022.06.019

Fenestrated and branched endografting (F/B-EVAR) has been proposed as an endovascular solution for chronic post-dissection thoraco-abdominal aneurysms (PD-TAAAs). The aim of this study was to analyse the experience of four high volume centres nationwide and the current available literature. Data on patients undergoing F/B-EVAR in four Italian academic centres between 2008 and 2019 were collected, and those from patients with PD-TAAAs were analysed retrospectively. Peri-operative morbidity and mortality were assessed as early outcomes. Survival, freedom from re-intervention (FFR), target visceral vessel (TVV) patency, and aortic remodelling were assessed as follow up outcomes. A MEDLINE search was performed for studies published from 2008 to 2020 reporting on F/B-EVAR in PD-TAAAs. Among 351 patients who underwent F/B-EVAR for TAAAs, 37 (11%) had PD-TAAAs (Crawford’s extent I–III: 35% – 95%). Overall, 135 TVVs (from true lumen 120; false lumen seven; both true and false lumen eight) were accommodated by fenestrations (96% – 71%) and branches (39% – 29%). Technical success (TS) was achieved in 34 (92%) cases with three failures due to endoleaks (Ia: 1; Ic: 1; III: 1). There were no 30 day deaths. No cases of permanent spinal cord ischaemia (SCI) were recorded and six (16%) patients suffered from transient deficits. Renal function worsening (eGFR < 30% than baseline) and pulmonary complications were reported in two (5%) and four (11%) cases, respectively. From the Kaplan–Meier analysis, three year survival, FFR, and TVV patency were 81%, 66%, and 97%, respectively. Radiological imaging was available for 30 (81%) patients at 12 months with complete false lumen thrombosis in 26 (87%). Two hundred and fifty-six patients were reported in seven published papers with TS, 30 day mortality, and SCI ranging from 99% to 100%, 0 to 6%, and 0 to 16%, respectively. The mean follow up ranged from 12 to 26 months, with estimated two year survival between 81% and 90% and a re-intervention rate between 19% and 53%. F/B-EVAR is effective to treat PD-TAAAs. A high re-intervention rate is necessary to complete the aneurysm exclusion and promote aortic remodelling successfully.