IFT16. Long-term Outcomes of Visceral and Renal Arteries in Patients Treated With Branched/Fenestrated Endografts for Complex Abdominal Aortic Aneurysms

Abstract

To retrospectively analyze perioperative and late Results of branched and fenestrated endografts implanted in patients with complex abdominal aortic aneurysms (AAA), paying particular attention to the long-term outcomes of stented visceral and renal arteries From January 2007 to August 2018, 953 endovascular repairs of AAA were performed. Data concerning these interventions were prospectively recorded in a certified institutional registry. A retrospective analysis of the registry was performed and 100 interventions performed for complex (thoracoabdominal, pararenal and juxtarenal) AAA were found. Perioperative analyzed. Follow-up program consisted of duplex ultrasound examination at 1 month and every 6 months and of angiocomputed tomography scan at 1 month and yearly thereafter. Follow-up Results were analyzed with Kaplan-Meier curves in terms of survival, freedom from AAA-related complications and reinterventions. Primary and secondary patency of the stented visceral and renal arteries were assessed. The indication for the intervention was a proximal para-anastomotic aneurysm following open aortic reconstruction in eight cases. Among the remaining 92 patients, 47 had a thoracoabdominal aneurysm, 34 a pararenal aneurysm and 11 a juxtarenal one. All but three patients had an elective intervention. In 58 cases, a fenestrated graft was placed, whereas in 17 cases a branched graft was used; 25 patients had both fenestrations and branches. Overall, 359 renal and visceral vessels were treated: 193 renal arteries, 94 superior mesenteric arteries and 72 celiac trunks. The technical success rate was 99%. Perioperative mortality was 4%; eight perioperative reinterventions were required. The overall complication rate was 21%, with nine cases of spinal cord ischemia, leading to paraplegia in four cases. Median duration of follow-up was 38 months (range, 1-98 months); all the patients who survived the intervention were followed-up. Estimated 5-year survival was 68.5% (standard error [SE], 0.05); there were neither ruptures nor conversions to open surgery. Freedom from reintervention at 5 years was 84.5% (SE, 0.05). Complications at the visceral and renal arteries occurred in five patients, in three cases requiring a reintervention: one acute thrombosis of both renal and visceral arteries, treated with thrombolysis, one thrombosis and one symptomatic stenosis of a renal artery, both treated with adjunctive stenting. Two patients with asymptomatic renal and mesenteric thrombosis were medically managed. The estimated 5-year primary and secondary patency rates were 85% (SE ,0.05) and 98.8% (SE, 0.06), respectively Late complications of the visceral and renal arteries following endovascular treatment of complex AAA are rare and they can be safely managed with endovascular means.