Degradation Phenomena on Second Generation of Explanted Aortic Textile Endografts

Abstract

s 403 3 Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, United Kingdom Department of Vascular and Endovascular Surgery, University Hospital South Manchester, Manchester, United Kingdom Introduction: We previously reported our early experience using the firstgeneration multi-layer flow modulating stent (MFMS) for patients with thoraco-abdominal (TAAA) and perirenal aneurysms (PAA) who were unsuitable for conventional EVAR and unfit for open repair. We encountered continued aneurysm growth, device component dislocation and re-intervention. Our study patients have now completed at least 3 years follow-up and we report the outcomes. Methods: Patients with TAAA and PAA unfit for open surgery and with no conventional options for endovascular repair were recruited by two UK vascular units. Follow-up included CTA at 1, 3, 6, and 12 months, then annually until 3 years. Outcome measures included 30 day mortality, growth-free survival, branch vessel patency, complications, re-intervention and maximal aortic diameter. Results: MFMS were implanted in 14 patients (6 PAA, 8 TAAA) between October 2011 and March 2014 with one (7%) 30 day death and 11 (79%) surviving to 12 months. The median aneurysm growth was 9 mm in the first 12 months following implantation. At current follow-up to death or at least 3 years, eleven patients (79%) have died including four confirmed ruptures, one presumed rupture, one confirmed dissection with rupture, one MI post-op (procedure related), one multi-organ failure following re-intervention (procedure related) one myocardial infarction (MI) (out of hospital e unrelated), one pneumonia (not device or procedure related), and one decompensated liver failure (unrelated). Continued aneurysm growth occurred in all patients who suffered rupture or dissection. AAA diameter remains stable in two of the three surviving patients. Fifty of 51 covered aortic branches remained patent with no embolic episodes or symptoms of ischaemia in any patient. MFMS dislocation occurred in four patients, leading to re-intervention in two. A total of six re-interventions were performed in five patients (35%) with one post re-intervention death. Conclusion: These first-generation MFMS were unstable and dislocated frequently. It is uncertain whether MFMS implantation influenced the natural history of these aneurysms as none decreased in size, but two remain stable after a mean of 42.5 months. Although side branch patency was maintained, rupture or dissection occurred in 43% of patients and our results do not support the continued use of these first-generation devices. Further development is needed as this technology has potential as demonstrated by the control of aneurysm rupture in three and growth in two patients. Disclosure of Interest: None Declared. SESSION 4 e MISCELLANEOUS (1) THU, 29 SEPT, 8:00e9:00