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Custom-Made Endograft for Endovascular Repair of Thoraco-Abdominal Aneurysm and Type B Dissection: Single-Centre Experience

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Abstract

Aims

To report a series of patients treated with the Jotec custom-made endograft for thoraco-abdominal aneurysms and dissections and identify predictive factors for re-intervention.

Methods

We retrospectively analysed 49 patients unsuitable for surgery, treated between 2011 and 2017 (71.3 ± 9.5 years; 15 females). Indications included Crawford type 4 aneurysm in 25 patients, type 3 in 13, type 2 in 4, type 1 in 2 and chronic aneurysmal dilatation of the false lumen following dissection in 5 cases. Mean aneurysm diameter was 58.7 ± 8.4 mm. The study aims were to assess procedural success, complications rate, mortality and long-term follow-up. We also analysed factors that predicted the need for re-intervention.

Results

The endograft was successfully deployed in all patients, catheterization of the fenestration and/or branches was achieved in 152/156 (97.4%) vessels. Early complications occurred in 10 patients (3 paraplegia, 3 haemorrhages, pancreatitis, aortic rupture, iliac artery rupture, 2 strokes). Thirty-day mortality was 10.2% and 180-day mortality 14.3%; two non procedure related deaths occurred. Mean follow-up was 23.6 ± 29.9 months [range 1–80]. No patients needed surgical explantation or developed significant renal impairment. Endoleak rate was 34.6% and re-intervention rate 9.7%. The aneurysm sac reduced or was stable in 36/49, and enlarged in 9/49 patients prompting re-intervention. Primary, primary-assisted and secondary patency of fenestrations/branches at 80 months was 90, 96 and 100%. Re-intervention was required more frequently in braches than in fenestrations, most commonly the external type branches.

Conclusions

The results of the Jotec endograft are comparable to other devices, with acceptable complication and re-intervention rates. Fenestration and inner-branch should be preferred due to lower re-intervention rates.

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Authors and Affiliations

  1. Vascular and Interventional Radiology Unit, Azienda Ospedaliera Universitaria Senese, Viale Mario Bracci, 16, 53100, Siena, Italy

    Pierleone Lucatelli, Marco Cini & Carmelo Ricci

  2. Vascular and Interventional Radiology Unit, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy

    Pierleone Lucatelli

  3. Cardiac and Great Vessels Surgery Unit, University of “Siena”, Viale Mario Bracci, 16, 53100, Siena, Italy

    Antonio Benvenuti, Giulio Tommasino, Giulia Guaccio & Eugenio Neri

  4. Department of Radiology, Azienda Ospedaliero Universitaria (AOU), di Cagliari - Polo di Monserrato s.s. 554, 09045, Monserrato (Cagliari), Italy

    Luca Saba

  5. University College, London Hospital, London, UK

    Graham Munneke

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  1. Pierleone Lucatelli
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  2. Marco Cini
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  3. Antonio Benvenuti
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Correspondence to Pierleone Lucatelli.

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All authors declare that they have no conflict of interests.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed Consent

Informed consent for the procedure for anonymized publication of this series of patients was obtained from all individual participants included in the study.

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Lucatelli, P., Cini, M., Benvenuti, A. et al. Custom-Made Endograft for Endovascular Repair of Thoraco-Abdominal Aneurysm and Type B Dissection: Single-Centre Experience. Cardiovasc Intervent Radiol 41, 1174–1183 (2018). https://doi.org/10.1007/s00270-018-1975-3

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  • DOI: https://doi.org/10.1007/s00270-018-1975-3

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