Anatomic characteristics associated with superior mesenteric artery stent graft placement during fenestrated para/suprarenal aneurysm repair

Jammeh, Momodou L.; Sánchez, Luis A.; Ohman, J. Westley

doi:10.1016/j.jvs.2022.01.019

Cited by 3 publications

(1 citation statement)

References 18 publications

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“…According to the literature, SMA stenting showed no increased risk of death, major adverse events, type 3 endoleaks, or reintervention, despite technical complexity. [123] Furthermore, catheterization and stenting the celiac trunk is often more challenging due to steep take off, angulation, and early branches. This study shows a median SAL of 28 (25,32) mm and median SAL in-crease for patients treated with 1-or 2-FSG configuration.…”

Section: Discussionmentioning

confidence: 99%

Geometric analysis of stent grafts to anticipate complications after endovascular aortic aneurysm repair

van der Riet

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Section: Discussionmentioning

confidence: 99%

Geometric analysis of stent grafts to anticipate complications after endovascular aortic aneurysm repair

van der Riet

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Mid-term proximal sealing zone evaluation after fenestrated endovascular aortic aneurysm repair

Riet

Schuurmann

et al. 2023

J Cardiovasc Surg

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BaCKground: fenestrated endovascular aortic aneurysm repair (fevar) is used in pararenal abdominal aortic aneurysms to achieve a durable proximal seal. This study investigated the mid-term course of the proximal fenestrated stent graft (FSG) sealing zone on the first and latest available post-fevar computed tomographic angiography (CTa) scan in a single-center series. MeThods: in 61 elective fevar patients, the shortest length of circumferential apposition between the fsg and the aortic wall (shortest apposition length [SAL]) was retrospectively assessed on the first and last available postoperative CTA scans. Patient records were reviewed for fevar-related procedural details, complications, and reinterventions. RESULTS: The median (interquartile range) time between the FEVAR procedure and the first and last CTA scan was 35 (30-48) days and 2.6 (1.2-4.3) years, respectively. The median (interquartile range) SAL was 38 (29-48) mm, and 44 (34-59) mm on the first and last CTA scans, respectively. During follow-up, the SAL increased >5 mm in 32 patients (52%), and decreased >5 mm in six patients (10%). Reintervention was performed for a type 1a endoleak in one patient. Twelve other patients needed 17 reinterventions for other fevar-related complications. ConClusions: good mid-term apposition of the fsg in the pararenal aorta was achieved post-fevar, and the occurrence of type 1a endoleaks was low. The number of reinterventions was substantial, however, but for reasons other than loss of proximal seal.

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Superior mesenteric artery-related outcomes in fenestrated/branched endografting for complex aortic aneurysms

Gallitto,

Faggioli,

Vacirca

et al. 2023

Front. Cardiovasc. Med.

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AimEarly/follow-up durability of superior mesenteric artery (SMA) stent-grafts is crucial after fenestrated/branched endografting (FB-EVAR) in complex abdominal aortic aneurysms (CAAAs) and thoracoabdominal aortic aneurysms (TAAAs). The study aimed to report early/midterm outcomes of SMA incorporated during FB-EVAR procedures.MethodsFB-EVAR procedures performed between 2016 and 2021 in a single institution were reviewed. Anatomical SMA characteristics were analyzed. The SMA configuration was classified into three types according to the angle between the SMA main trunk and the aorta: (A) perpendicular, (B) downward, and (C) upward. SMA-related technical success (SMA-TS: cannulation and stenting, patency at completion angiography without endoleak, stenosis/kinking, dissection, bleeding, and 24-h mortality) and SMA-adverse events (SMA-AEs: one among bowel ischemia, stenosis, occlusion, endoleak, reinterventions, or SMA-related mortality) were assessed.ResultsTwo hundred FB-EVAR procedures with SMA as the target artery were performed. The indication for FB-EVAR was CAAAs and TAAAs in 99 (49%) and 101 (51%) cases, respectively. The SMA configuration was A, B, and C in 132 (66%), 63 (31%), and 5 (3%) cases, respectively. SMA was incorporated with fenestrations and branches in 131 (66%) and 69 (34%) cases, respectively. Directional branch (P < .001), aortic diameter ≥35 mm at the SMA level (P < .001), and ≥2 SMA bridging stent-grafts (P = .001) were more frequent in TAAAs. Relining of the SMA stent-graft with a bare metal stent was necessary in 41 (21%) cases to correct an acute angle between the stent-graft and native artery (39), stent-graft stenosis (1), or SMA dissection (1). Relining was associated with type A or C SMA configuration (OR: 17; 95% CI: 1.8–157.3; P = .01). SMA-TS was achieved in all cases. Overall, 15 (7.5%) patients had SMA-AEs [early: 9 (60%), follow-up: 6 (40%)] due to stenosis (2), endoleak (8), and bowel ischemia (5). Aortic diameter ≥35 mm at the SMA level was an independent risk factor for SMA-AEs (OR: 4; 95% CI: 1.4–13.8; P = .01). Fourteen (7%) patients died during hospitalization with 10 (5%) events within the 30-postoperative day. Emergency cases (OR: 33; 95% CI: 5.7–191.3; P = .001), peripheral arterial occlusive disease (OR: 14; 95% CI: 2.3–88.8; P = .004), and bowel ischemia (OR: 41; 95% CI: 1.9–87.9; P = .01) were risk factors for 30-day/in-hospital mortality. The mean follow-up was 32 ± 24 months; estimated 3-year survival was 81%, with no case of late SMA-related mortality or occlusion. The estimated 3-year freedom from overall and SMA-related reinterventions was 74% and 95%, respectively.ConclusionSMA orientation determines the necessity of stent-graft relining. Aortic diameter ≥35 mm at the SMA level is a predictor of SMA-AEs. Nevertheless, SMA-related outcomes of FB-EVAR are satisfactory, with excellent technical success and promising clinical outcomes during the follow-up.

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Anatomic characteristics associated with superior mesenteric artery stent graft placement during fenestrated para/suprarenal aneurysm repair

Cited by 3 publications

References 18 publications

Geometric analysis of stent grafts to anticipate complications after endovascular aortic aneurysm repair

Geometric analysis of stent grafts to anticipate complications after endovascular aortic aneurysm repair

Mid-term proximal sealing zone evaluation after fenestrated endovascular aortic aneurysm repair

Superior mesenteric artery-related outcomes in fenestrated/branched endografting for complex aortic aneurysms

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