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Tsilimparis N, Prendes CF, Rouhani G, et al. Pre-Loaded Fenestrated Thoracic Endografts for Distal Aortic Arch Pathologies: Multicentre Retrospective Analysis of Short and Mid Term Outcomes. Eur J Vasc Endovasc Surg. 2021;62(6):887-895doi: 10.1016/j.ejvs.2021.08.018.
Tsilimparis, N., Prendes, C. F., Rouhani, G., Adam, D., Dias, N., Stana, J., Rohlffs, F., Mani, K., Wanhainen, A., & Kölbel, T. (2021). Pre-Loaded Fenestrated Thoracic Endografts for Distal Aortic Arch Pathologies: Multicentre Retrospective Analysis of Short and Mid Term Outcomes. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery, 62(6), 887-895. https://doi.org/10.1016/j.ejvs.2021.08.018
Tsilimparis, Nikolaos, et al. "Pre-Loaded Fenestrated Thoracic Endografts for Distal Aortic Arch Pathologies: Multicentre Retrospective Analysis of Short and Mid Term Outcomes." European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery vol. 62,6 (2021): 887-895. doi: https://doi.org/10.1016/j.ejvs.2021.08.018
Tsilimparis N, Prendes CF, Rouhani G, Adam D, Dias N, Stana J, Rohlffs F, Mani K, Wanhainen A, Kölbel T. Pre-Loaded Fenestrated Thoracic Endografts for Distal Aortic Arch Pathologies: Multicentre Retrospective Analysis of Short and Mid Term Outcomes. Eur J Vasc Endovasc Surg. 2021 Dec;62(6):887-895. doi: 10.1016/j.ejvs.2021.08.018. Epub 2021 Oct 08. PMID: 34629278.
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Eur J Vasc Endovasc Surg. 2021 Dec;62(6):887-895. doi: 10.1016/j.ejvs.2021.08.018. Epub 2021 Oct 08.

Pre-Loaded Fenestrated Thoracic Endografts for Distal Aortic Arch Pathologies: Multicentre Retrospective Analysis of Short and Mid Term Outcomes.

European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery

Nikolaos Tsilimparis, Carlota F Prendes, Guido Rouhani, Donald Adam, Nuno Dias, Jan Stana, Fiona Rohlffs, Kevin Mani, Anders Wanhainen, Tilo Kölbel

Affiliations

  1. Department of Vascular Surgery, Ludwig Maximilians University Hospital, Munich, Germany. Electronic address: [email protected].
  2. Department of Vascular Surgery, Ludwig Maximilians University Hospital, Munich, Germany.
  3. Section of Vascular Surgery, Klinikum Frankfurt Höchst, Frankfurt, Germany.
  4. Department of Vascular and Endovascular Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
  5. Department of Vascular Surgery, Malmö Vascular Centre, Sweden.
  6. German Aortic Centre Hamburg, Department of Vascular Medicine, Hamburg, Germany.
  7. Department of Surgical Sciences, Vascular Surgery, Uppsala University, Sweden.
  8. Department of Surgical Sciences, Vascular Surgery, Uppsala University, Sweden; Department of Surgical and Peri-operative Sciences, Umeå University, Sweden.

PMID: 34629278 DOI: 10.1016/j.ejvs.2021.08.018

Abstract

OBJECTIVE: To determine short and midterm outcomes of a pre-loaded fenestrated thoracic endograft (f-TEVAR) for exclusion of distal aortic arch pathologies.

METHODS: This was a multicentre, retrospective study including consecutive patients from six experienced European vascular centres undergoing f-TEVAR for distal arch pathologies. Primary endpoints included peri-operative mortality and peri-operative stroke and/or spinal cord ischaemia rates. Secondary outcomes were technical success and mid to late events, including death and re-interventions. Statistical analysis was performed with SPSS 26. Mid to late term events were calculated using Kaplan-Meier survival analysis.

RESULTS: One hundred and eight patients were included (mean age 68 ± 11 years, 70% men). A total of 38% (n = 42) had a prior history of aortic dissection, and 24% (n = 26) prior aortic surgery. The mean aneurysm diameter was 59 ± 12 mm and the most frequent indication for treatment was post-dissection aneurysms (n = 42, 39%). Technical success was 99% (n = 107) despite intra-operative wire entanglement occurring in 29% (n = 31). The 30 day mortality rate was 3.7% (n = 4), with a 5.6% major stroke incidence (n = 6) and 3.7% (n = 4) spinal cord ischaemia rate. Three cases of retrograde dissection occurred (two of which were fatal), all in post-type B dissecting aneurysm patients without prior aortic surgery (three of 19, 15.8%). Median follow up was 12 months (range, 1 - 26). Endoleaks were documented during follow up, with 3.5% type Ia (4/104) and 2.9% type Ib (3/104) as a result of persistent false lumen perfusion. The one, two, and three year survivals and freedom from re-intervention rates were 93.2% and 92.1%, 89.1% and 86.3%, and 84.4% and 73%, respectively.

CONCLUSION: This multicentre study shows that treatment of the distal aortic arch by f-TEVAR is feasible, with promising 30 day mortality, stroke, and spinal cord ischaemia rates.

Copyright © 2021. Published by Elsevier B.V.

Keywords: Aneurysm; Aorta; Arch repair; Endovascular; Fenestrated; Post-dissecting

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