Technical Success and Long-Term Results with Excluder/C3 Endoprosthesis in Narrow Aortic Bifurcations: First Italian Multicentre Experience

Abstract

This study aims at evaluating technical success and long-term results using GoreExcluder/C3 endoprosthesis in patients with narrow aortic bifurcation (NAB; inner aortic diameter < 18mm). Clinical and anatomical data were collected retrospectively from patients treated in 2 high-volume Italian vascular centers between 2005 and 2017. A total of 1325 endovascular aneurysm repair procedures were performed, of which 195 involved Excluder/C3 Gore endoprosthesis. One hundred forty-one patients had a regular aortic bifurcation (RAB; maximum inner diameter≥18mm), whereas 54 presented with NAB (<18mm). Technical success and procedural time were considered as primary outcomes. Secondary outcomes were perioperative complications, long-term graft-related complications and reintervention rates. Demographic data and risk factors were similar in the 2 groups. The mean diameter of aortic bifurcation was 29.8 ±10.4mm in RAB versus 17.1 ± 0.9mm in NAB. Technical success was 100% in both groups. Incidence of intraoperative kinking/stenosis of limb graft was significantly higher in NAB (40.7% vs. 12.8%; P<0.001), which was treated by means of kissing balloon technique (KiBaTe) and selective stenting. Time of procedure was similar. Post-operative complications rate was similar in both the groups (9.5% in RAB versus 4.2% in NAB, P=0.180). Mean follow-up period was 40.0months (range, 1-130). No significant difference was registered in long-term graft-related complications between RAB and NAB (38.3% vs. 38.8%; P=0.939). Reintervention rate after 70months was 21.8% vs. 24.6% in RAB and NAB, respectively (log rank = 0.517). Primary patency at 6, 12, and 48months was 99.3% vs. 100%, 99.3% vs. 100%, and 98.5% vs. 97.9%, respectively (log rank = 0.497). Assisted primary patency was 98.6% vs. 96.0%, 97.8% vs. 96.0%, and 97.8% vs. 96.0%, respectively (log rank = 0.789). Secondary patency was 100% in both the groups. Endovascular aneurysm repair of NAB using Gore Excluder/C3 graft can be considered safe and effective in early and late follow-up. Intraoperative graft kinking is frequent in NAB and KiBaTe is recommended to prevent occlusive complications.