Results of Bi-tubular Prostheses in the Laparoscopic Treatment of the Aneurysms of the Abdominal Aorta

Abstract

performances of robotic navigation with the Magellan system (Hansen Medical) for the endovascular treatment of complex aortic aneurysms (CAA) and peripheral vascular pathologies (PVP). Materials and Methods: Between February and October 2013, the robotic catheter was used in 28 patients presenting a CAA (n1⁄413) or a PVP (n1⁄415). The CAA included: five thoracoabdominal aneurysms (three type III, one type II and one type IV), four juxtarenal aneurysms, twopara-renal aneurysms and two suprarenal aneurysms. The patients were treated with fenestrated (n1⁄49), fenestrated and branched (n1⁄42), branched (n1⁄41) SG or by a chimney technique (n1⁄41). In theCAAgroup, the robotic systemwasused for the catheterization of 34 target arteries (24 renal arteries, 8 superiormesenteric arteries and two celiac trunks) vascularized via 26 fenestrations, six branches and two chimney stents. The PVP included: six embolizations, five obliterating arterial diseases of the lower extremities, three carotid stentings and one renal stenting. For each target artery, 15minutes were allocated to robotic navigation. In the event of failure of catheterization after 15minutes of robotic navigation, conventional catheters were used. Results: In the CAA group, 27/34 (79%) target arteries could be catheterized in less than 15minutes, with amedian time of catheterization of 4min 10sec (range: 40sec 10min 25s). For seven renal arteries vascularized via seven fenestrations, the robotic system did not allow catheterization in less than 15 min. These seven arteries could be catheterized by using conventional catheters with a median time of 32 minutes. All the target arteries vascularized by branches or chimney stents could be catheterized in less than 15 minutes with the robotic system. In the PVP group, all the lesions (n1⁄415) could be reached or crossed in less than 15 minutes by using the robotic system. Among the 28 patients included, no traumatic lesion was noted with the vascular site of access, nor at the level of the treated site. Conclusion: The use of the robotic system for arterial catheterization is feasible and safe. In our experiment, these performances were optimal for PVP and the catheterization of stentgraft branches or the deployment of chimney-stents.