Endovascular Treatment of Complex Aortic Aneurysms Using the Sandwich Technique

Abstract

To assess the safety and efficacy of the sandwich technique for complex aortic aneurysms. Between October 2008 and March 2012, 78 patients (70 men; mean age 73.3 years) undergoing complex thoracic or abdominal endovascular aneurysm repairs were treated with the sandwich technique when the aneurysm features did not fulfill the requirements for standard endovascular techniques or total aortic arch replacement. Two thirds of the population was treated for aortoiliac aneurysm (52, 66.7%). There were 15 (19.2%) thoracoabdominal aneurysms, 6 (7.7%) isolated iliac artery aneurysms, 3 (3.8%) arch aneurysms, and 2 (2.6%) abdominal aortic aneurysm with non-diseased, short common iliac arteries bilaterally. Five (6.4%) symptomatic patients were submitted to endovascular repair in the urgent setting. Technical success was 98.7%; one procedure was aborted when both renal arteries could not be cannulated. Over a mean 17-month follow-up (range 1-42), primary patency was high (96.7%) and mortality low (early: 5.1%, late: 1.3%). Overall, only 4 (5.1%) type II endoleaks persisted: 3 early with no sac increase and 1 late with sac increase that was managed conservatively on patient demand (stable at 9 months). In all other aneurysms except the 3 in the arch, there was a 5-mm reduction in size achieved by the end of the second year of follow-up, though this was significant only in the aortoiliac aneurysm group (p<0.005). The sandwich technique facilitates safe and effective aneurysm exclusion and target vessel revascularization in adverse anatomical scenarios, with sustained durability in midterm follow-up.