1. Preliminary Outcomes of Viabahn Balloon-Expandable Endoprosthesis as Bridging Stent in Renal Arteries During Fenestrated Endovascular Aortic Repair
- Author
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Luca Mezzetto, Michele Piazza, Francesco Squizzato, Roberto Silingardi, Stefano Gennai, Gian Franco Veraldi, Michele Antonello, Davide Mastrorilli, Nicola Leone, Mezzetto L., Mastrorilli D., Leone N., Gennai S., Silingardi R., Veraldi G.F., Piazza M., Squizzato F., and Antonello M.
- Subjects
Time Factors ,Thoracic ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Endovascular aneurysm repair ,0302 clinical medicine ,Renal Artery ,Retrospective Studie ,Risk Factors ,Stent ,thoracoabdominal aortic aneurysm ,030212 general & internal medicine ,balloon-expandable stent ,fenestrated repair ,renal artery ,Blood Vessel Prosthesis ,Humans ,Netherlands ,Prosthesis Design ,Retrospective Studies ,Stents ,Treatment Outcome ,Aortic Aneurysm, Abdominal ,Aortic Aneurysm, Thoracic ,Blood Vessel Prosthesis Implantation ,Endovascular Procedures ,Aortic Aneurysm ,Blood Vessel Prosthesi ,Balloon expandable stent ,Cardiology and Cardiovascular Medicine ,Human ,medicine.medical_specialty ,Bridging (networking) ,Time Factor ,Aortic repair ,03 medical and health sciences ,Netherland ,Blood vessel prosthesis ,medicine.artery ,medicine ,Abdominal ,Radiology, Nuclear Medicine and imaging ,Renal artery ,business.industry ,Risk Factor ,Surgery ,business - Abstract
Purpose: To report preliminary outcomes of Viabahn Balloon-Expandable Endoprosthesis (VBX) stent-graft as bridging stent for renal arteries in fenestrated endovascular aneurysm repair (FEVAR). Materials and Methods: Between 2018 and 2019, patients undergoing FEVAR at 3 referral Italian university hospitals were prospectively collected. During the study period, VBX was the first-line choice as bridging stent for renal arteries. Procedural and anatomical data were analyzed, including renal artery (RA) configuration. A dedicated software (3Mensio, Vascular Imaging, Bilthoeven, The Netherlands) was used and RA anatomy classified as follow: upward-oriented in case of any angle >30° above the horizontal or transverse axis perpendicular to the aortic axis, downward-oriented if there was an angle >30° measured below the transverse axis and downward + upward in case of an angle 90°. Primary endpoints were technical success, defined as complete deployment of the fenestrated endograft without target vessel (TV) loss, limb stenosis or occlusion and type I or III endoleak, and freedom from target artery instability (TAI), defined by target vessel-related death, occlusion, rupture or reintervention for stenosis, endoleak or disconnection. Secondary endpoints were target artery patency rate and freedom from reinterventions. Results: A total of 26 elective FEVAR for juxta/pararenal aneurysm (20), thoracoabdominal type II (3) and type IV (3) were included. Fifty-one RA were planned for revascularization. Of these, 32 were downward, 10 horizontal, 6 upward, 4 were downward + upward. Technical success was achieved in 88.5% (23/26) of patients and 94.2% (48/51) of the TVs. One occlusion (2.1%) occurred within 30 days in a patient with previous endovascular aortic repair and suprarenal fixation. During follow-up (median 10 months), there was 1 type IC endoleak after 6 months (2.1%) in a patient with upward plus downward arterial orientation. Freedom from TAI was 96.1% (CI = 0.89 to 1.04) at first month and 92.3% (CI = 0.82 to 1.03) at 6 months. No aneurysm-related mortality and renal insufficiency occurred during follow-up. Conclusion: The use of VBX as bridging stent of RA in FEVAR is safe and feasible. Previous EVAR and tortuosity of RA may be a challenging on target vessel fate.
- Published
- 2021