IPC07. Outcomes of Standard Versus Low-Profile Fenestrated-Branched Endovascular Aortic Repair for Pararenal and Thoracoabdominal Aneurysms

Abstract

The aim of this study was to compare outcomes of standard-profile (SP) and low-profile (LP) fenestrated and branched stent grafts for treatment of pararenal and thoracoabdominal aortic aneurysms. We reviewed the clinical data of all consecutive patients enrolled in a prospective, nonrandomized study to investigate fenestrated-branched endovascular aortic repair (F-BEVAR) for PRAs and TAAAs between 2013 and 2018. Outcomes were analyzed in patients treated with SP (22F) or LP (18-20F) off-the-shelf or patient-specific devices with up to five fenestrations or branches. End points were access-related complications (iliofemoral rupture, dissection, thrombosis), need for iliac conduit, procedural metrics, major adverse events, and mortality. There were 298 patients treated by F-BEVAR (71% male; mean age, 74 ± 8 years old), including 118 patients (40%) with extent I to III TAAAs, 78 patients (26%) with extent IV TAAAs, and 102 patients (34%) with PRAs. SP stent grafts were used in 186 patients (62%) and LP devices in 112 patients (38%). LP devices were more frequently used for chronic dissections (13% vs 4%; P = .009) and for extent I to III TAAAs (57% vs 30%; P < .0001) compared with SP devices. Preloaded catheters were used in 126 patients (68%) treated with SP devices, whereas preloaded guidewire systems were used in 68 patients (61%) who had LP stent grafts. A total of 1144 target vessels were incorporated with a mean of 3.9 ± 0.6 vessels per patient in both groups (P = .17). There were no differences in procedural metrics (Table I), including total operating time, estimated blood loss, contrast use, and radiation exposure between SP and LP devices, respectively. Technical success was similar in patients who had SP and LP stent grafts (98% vs 95%; P = .07), respectively. There were six access-related complications (four ruptures, one dissection and one thrombosis), all in patients treated by SP devices (P = .05). Autotransfusion was used more often in patients treated with SP compared with LP devices (32% vs 19%; P = .02). Iliac conduits were required in 11 patients (6%) treated with SP and in 2 (2%) who had LP devices (P = .09). Overall, two patients (1%) died at 30 days and 83 (28%) had major adverse events, without significant differences in between groups (Table II). F-BEVAR was performed with similar procedural metrics and early outcomes using either SP or LP devices. LP devices were associated with less access-related complications, less autotransfusion requirement, and a nonsignificant trend toward less need for iliac conduits.Table IProcedures metrics and technical successOverall (n = 298)Standard-profile (n = 186)Low-profile (n = 112)P valueContrast volume, mL154 ± 56156 ± 58151 ± 54.47Fluoroscopy time, min83 ± 3282 ± 3184 ± 33.51Total endovascular time, min165 ± 63166 ± 59164 ± 69.87Total operation time, min245 ± 80248 ± 78240 ± 82.41Estimated blood loss, mL441 ± 505454 ± 493419 ± 525.57Technical success per patients289/298 (96.9)183/186 (98.3)106/112 (94.6).07Values are number (%) or mean ± standard deviation. Open table in a new tab Table IIEarly outcomesOverall (n = 298)Standard-profile (n = 186)Low-profile (n = 112)P valueAny MAE83 (28)49 (26)34 (30).45Death2 (1)1 (1)1 (1).71EBL >1 L25 (8)16 (9)9 (8).86AKI by RIFLE criteria43 (14)26 (14)17 (15).77New-onset dialysis6 (2)4 (2)2 (2).83Myocardial infarction10 (3)6 (3)4 (4).87Respiratory failure6 (2)3 (2)3 (3).52Paraplegia8 (3)5 (3)3 (3).99Permanent paraplegia4 (1)2 (1)2 (2).61Major stroke2 (1)1 (1)1 (1).71Bowel ischemia5 (2)3 (2)2 (2).91AKI, Acute kidney injury; EBL, estimated blood loss; MAE, major adverse event; RIFLE, Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease.Values are number (%). Open table in a new tab