Abstract
BackgroundSurgical management of patients with abdominal aortic diseases associated with distal narrowing is a challenging situation.ObjectivesTo evaluate outcomes of unibody bifurcated endovascular stent graft repair.MethodsThis is a retrospective, observational, multi-institutional database study of a cohort of consecutive cases, approved by the local Ethics Committee. Records were reviewed of patients diagnosed from 2010 to 2020 with “shaggy” aorta, saccular aneurysm, penetrating aortic ulcer, and isolated aortic dissection located in the infrarenal abdominal aorta. All patients were treated with a unibody bifurcated stent graft. Main outcomes were technical success, procedure complications, long-term patency, and mortality in the follow-up period up to 5 years. Data on demographics, comorbidities, surgical management, and outcomes were analyzed.ResultsTwenty-three patients were treated with unibody bifurcated stent graft repair, including 7 cases of “shaggy” aorta, 3 isolated dissections of the abdominal aorta, 4 penetrating aortic ulcers, and 9 saccular aneurysms. Immediate technical success was achieved in 100% of cases. At follow-up, all stent grafts remained patent and there were no limb occlusions. The patients were symptom-free and reported no complications related to the procedure. There were 5 deaths during the follow-up period (median= 4 years), but none were related to the procedure and there were no aorta-related deaths.ConclusionsThe present study shows that unibody bifurcated stent grafting is safe and effective in this group of patients with narrow distal abdominal aorta and complex aortic pathology. The results were similar for both infrarenal aortic aneurysms and aorto-iliac atherosclerotic disease.
Highlights
Penetrating aortic ulcer,[1,2] saccular aneurysm,[3,4] diffuse atherosclerotic aortic disease (“shaggy aorta”),[5,6,7] and isolated dissection of the abdominal aorta[8] constitute a group of heterogenous and infrequent aortic lesions with a normal or narrow diameter of the abdominal aortic bifurcation.[2,9] We have arbitrarily called this disease group “narrow distal abdominal aortic diseases” (NDAAD)
It has predominantly been used in atherosclerotic and non-aneurysmal aortic diseases, but these studies report a small number of patients and none have included all NDAAD together in a single series.[13,14]
In another study involving 112 patients with abdominal aortic aneurysms with narrow distal aorta, the unibody bifurcated stent graft was only used in 10 cases, with the advantage of not requiring gate catheterization.[12]
Summary
Penetrating aortic ulcer,[1,2] saccular aneurysm,[3,4] diffuse atherosclerotic aortic disease (“shaggy aorta”),[5,6,7] and isolated dissection of the abdominal aorta[8] constitute a group of heterogenous and infrequent aortic lesions with a normal or narrow diameter of the abdominal aortic bifurcation.[2,9] We have arbitrarily called this disease group “narrow distal abdominal aortic diseases” (NDAAD). It has predominantly been used in atherosclerotic and non-aneurysmal aortic diseases, but these studies report a small number of patients and none have included all NDAAD together in a single series.[13,14] In another study involving 112 patients with abdominal aortic aneurysms with narrow distal aorta, the unibody bifurcated stent graft was only used in 10 cases, with the advantage of not requiring gate catheterization.[12]. Results: Twenty-three patients were treated with unibody bifurcated stent graft repair, including 7 cases of “shaggy” aorta, 3 isolated dissections of the abdominal aorta, 4 penetrating aortic ulcers, and 9 saccular aneurysms. The results were similar for both infrarenal aortic aneurysms and aorto-iliac atherosclerotic disease
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