Abstract
PurposeTo evaluate bridging stent geometry in patients who underwent branched endovascular aortic repair (B-EVAR) and to correlate the outcomes with intrinsic bridging stent characteristics aiming to identify the stent(s) that guarantees the best performance.MethodsPre-operative and post-operative computed tomography images of all patients undergoing B-EVAR between September 2016 and April 2019 were retrospectively analyzed. Following geometrical features were measured: target vessel take-off angle (TOA); longitudinal stent shortening; shape index (SI), intended as ratio between minimum and maximum diameter of the lumen cross sections, averaged on three segments: zone 1 (proximal stented zone), zone 2 (intermediate), and zone 3 (distal).ResultsThirty-eight branches (8 right (RRA) and 8 left renal arteries (LRA), 11 superior mesenteric arteries (SMA), 11 celiac trunks (CTR)) were treated. Fluency (Bard Peripheral Vascular), COVERA (Bard Peripheral Vascular), and VBX (WLGore&Assoc) stent-grafts were implanted in 10, 12, and 16 branches, respectively. Pre-operative TOA was more acute in RRA and LRA when compared to CTR and SMA, and straightened in post-operative configuration (109.86 ± 28.65° to 150.27 ± 21.0°; P < 0.001). Comparable values of SI among the stent types were found in zone 1 (P = 0.08), whereas higher SI in VBX group was detected in zones 2 (P < 0.001) and 3 (P < 0.001). The VBX group was also the most affected by stent shortening (11.12 ± 5.65%; P = 0.001).ConclusionOur early experience showed that the VBX stent offers greater stent circularity than the other devices even if a greater shortening has been observed drawing attention with regards to the decision of the nominal stent length.
Highlights
In the recent years, with the introduction of fenestrated endovascular aneurysm repair (F-EVAR) and more recently branched stent-graft (B-EVAR), endovascular repair has become a valid solution in the treatment of thoracoabdominal aortic aneurysms (TAAA) for those patients not suitable for open surgery [1,2,3]
Preoperative take-off angle (TOA) was more acute in right renal arteries (RRA) and LRA when compared to celiac trunks (CTR) and superior mesenteric arteries (SMA), and straightened in post
With the introduction of fenestrated endovascular aneurysm repair (F-EVAR) and more recently branched stent-graft (B-EVAR), endovascular repair has become a valid solution in the treatment of thoracoabdominal aortic aneurysms (TAAA) for those patients not suitable for open surgery [1,2,3]
Summary
With the introduction of fenestrated endovascular aneurysm repair (F-EVAR) and more recently branched stent-graft (B-EVAR), endovascular repair has become a valid solution in the treatment of thoracoabdominal aortic aneurysms (TAAA) for those patients not suitable for open surgery [1,2,3]. The choice between the two types of configurations (F-EVAR vs B-EVAR) is usually made on the basis of the target vessel aortic diameter as well as orientation of renal arteries [4, 5]. Comparative studies have recently been published demonstrating that patency for the side branches is greater when F-EVAR is adopted, while the reoperation rates are lower in cases where branches were used [6]. Occlusion causes in B-EVAR could be related to the greater length of the branch stents if compared to the fenestrated ones and to the angles that are induced along the stent in the case of B-EVAR [7]. [8] with off-theshelf multibranched endografts and bridging for visceral and renal vessel performed by balloon-expandable and/or self-expanding covered stents showed at median follow-up of 18 months, 3 of 73 cases of branch occlusion and 5 reinterventions The multicentric experience reported by Silingardi et el. [8] with off-theshelf multibranched endografts and bridging for visceral and renal vessel performed by balloon-expandable and/or self-expanding covered stents showed at median follow-up of 18 months, 3 of 73 cases of branch occlusion and 5 reinterventions
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