Comparison of outcomes for double fenestrated endovascular aneurysm repair versus triple or quadruple fenestrated endovascular aneurysm repair in the treatment of complex abdominal aortic aneurysms

Katsargyris, Αthanasios; Oikonomou, Kyriakos; Kouvelos, George; Mufty, Hozan; Ritter, W.; Verhoeven, Eric L.G.

doi:10.1016/j.jvs.2016.11.043

Cited by 71 publications

(55 citation statements)

References 14 publications

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“…This study, however, did show that more extensive aneurysms resulted in greater KAP than more straightforward FEVARs. This finding is similar to that from Katsargyris et al, 13 who recently published there results on standard FEVAR (renal artery fenestrations) versus more complex FEVARs (additional fenestrations for the visceral vessels). This group found a longer fluoroscopy time for complex FEVARs compared with more routine FEVARs.…”

Section: Discussionsupporting

confidence: 90%

Patient and operating room staff radiation dose during fenestrated/branched endovascular aneurysm repair using premanufactured devices

Kirkwood

Chamseddin

Arbique

et al. 2018

Journal of Vascular Surgery

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Introduction: Fenestrated endovascular aneurysm repair (FEVAR) is the highest radiation dose procedure performed by vascular surgeons. We sought to characterize the radiation dose to patients and staff during FEVAR procedures with different premanufactured devices. Methods: A single-center prospective study of FEVARs was performed over 24 months. Three FEVAR devices were included: off-the-shelf (OTS; t-Branch, p-Branch), Zenith Fenestrated (ZFen), and investigational custom-made devices (CMDs). Radiation doses to the surgeon, trainee, anesthesiologist, and scrub/circulating nurses were measured using a personal dosimetry system (DoseAware, Philips Healthcare, Amsterdam, The Netherlands). Procedure type, patient body mass index (BMI), reference air kerma (RAK), and kerma area product (KAP) were recorded. RAK and KAP were corrected for BMI based on an exponential fit of fluoroscopy dose rate and the dose per radiographic frame. Operator dose was corrected for BMI by the ratio of corrected to actual KAP. A one-sided Wilcox rank-sum test was used to compare personnel radiation doses, RAKs, and KAPs between procedure types. Statistical significance was set at P # .05. Results: There were 80 FEVARs performed by a single surgeon on a Philips Allura XperFD20 fluoroscopy system equipped with Clarity technology. Average BMI was 27 kg/m 2. Sixty CMDs (36 four-, 21 three-, and 3 two-vessel fenestrations), 11 ZFens (8 three-and 3 two-vessel fenestrations), and 9 OTS devices (4 p-Branch, 5 t-Branch) were included. ZFens had significantly lower patient (1800 mGy vs 2950 mGy; P ¼ .004), operator (120 mSv vs 370 mSv; P ¼ .004), assistant (60 mSv vs 210 mSv; P ¼ .003), circulator (10 mSv vs 30 mSv; P ¼ .049), and scrub nurse dose (10 mSv vs 40 mSv; P ¼ .02) compared with CMDs. OTS devices had significantly lower operator (220 mSv vs 370 mSv; P ¼ .04), assistant (110 mSv vs 210 mSv; P ¼ .02), and circulator doses (4 mSv vs 30 mSv; P ¼ .001) compared with CMDs. Four-vessel fenestrated devices had significantly higher patient dose (3020 mGy) compared with three-vessel FEVARs (2670 mGy; P ¼ .03) and two-vessel FEVARs (1600 mGy; P ¼ .0007), and significantly higher operator dose (440 mSv) compared with three-vessel FEVARs (170 mSv; P ¼ .0005). Patient dose was lowest with ZFens. Operating room personnel dose was lower with ZFens and OTS devices compared with CMDs. Fourvessel fenestrations required significantly more radiation compared with those involving three-vessel fenestrations; however, the dose increase was only 12% and should not preclude operators from extending coverage, if anatomically required. Conclusions: Overall, patient and personnel radiation doses during FEVAR with all devices were within acceptable limits and lower in our series than previously reported.

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Section: Discussionsupporting

confidence: 90%

Patient and operating room staff radiation dose during fenestrated/branched endovascular aneurysm repair using premanufactured devices

Kirkwood

Chamseddin

Arbique

et al. 2018

Journal of Vascular Surgery

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“…Studies from around the world routinely report high branch artery patency, few or absent type IA endoleaks, and low reintervention rates compared with even standard EVAR. [1][2][3][4][5][6]16,17 The absence of type IA endoleaks and 100% branch artery patency in initially preserved vessels in both arms of our series to date support FEVAR as the therapy of choice for the JAAA patient, provided the fenestration locations are accurately planned. Limitations with the current software version have been identified as two additional patients in this series had CT scans rejected by the software and were treated on the basis of the manual planning method.…”

Section: Discussionsupporting

confidence: 56%

“…Long-term durability, branch artery patency, and low rates of type IA endoleak and reintervention are among the benefits of the therapy. [1][2][3][4][5][6] By design, FEVAR results in proximal endograft deployment in healthy parallel walled aorta well above the aneurysm, and this likely contributes to its success through robust sealing and protection against aneurysmal disease progression. Fenestrations in the endograft allow blood flow to vital organs.…”

mentioning

confidence: 99%

Procedural and perioperative results in patients treated with fenestrated endovascular aneurysm repair planned by automated software in a physician-sponsored investigational device exemption trial of physician-modified endografts

Starnes

Tatum

Singh

2018

Journal of Vascular Surgery

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“…Katsargyris et al have recently compared 1- and 3-year outcomes for standard and complex fenestrated EVAR procedures, finding no differences in mortality or morbidity, with similar rates of technical success. 25 They argued that the increased procedural and fluoroscopy times should not prohibit a more liberal use of complex FEVAR procedures. The expertise harbored at their center is reflected in their results, yet replicability at other centers may require further scrutiny.…”

Section: Discussionmentioning

confidence: 99%

Correlations Between Branch Vessel Catheterization and Procedural Complexity in Fenestrated and Branched Endovascular Aneurysm Repair

Budtz-Lilly

Liungman

Wanhainen

et al. 2019

Vasc Endovascular Surg

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Introduction: The use of fenestrated and branched endovascular technologies in complex aortic aneurysm repair (F/BEVAR) is increasing, with a trend toward using longer sealing zones and incorporating more target vessels. Successful aneurysm exclusion and prevention of long-term treatment failure need to be balanced against the increased complexity of more extensive procedures. The aim of this study was to analyze relationships between the number of catheterized vessels and multiple operative variables as a means for evaluating procedural complexity. Methods: Operative data from consecutive F/BEVAR procedures performed at a single center from 2012 to 2015 were analyzed. An equal number of EVAR procedures, randomly selected, from this period were also analyzed. Only intact aneurysms were included. Complex aneurysms were grouped based on the required number of target vessel catheterization. Ten procedural variables, categorized as perioperative, postoperative, and radiologic-related, were compared. Pearson correlation analysis and regression analysis were performed. The correlation coefficients, r, were classified using Cohen boundaries, r ≥ 0.5 indicating a strong relationship. Results: There were 63 EVAR, 40 FEVAR, and 22 BEVAR procedures. There was no significant difference in patient comorbidities between conventional EVAR and complex procedure groups. The complex procedures included 23 two-vessel, 20 three-vessel, and 19 four-vessel catheterizations. Strong linear relationships between the number of branch vessel catheterizations and the following variables were identified: accumulated skin dose (r = .504), contrast volume (r = .652), fluoroscopy duration (r = .598), number of angiography series (r = .650), anesthesiology duration (r = .742), procedure duration (r = .554), and total length of stay (r = .533). Conclusion: The complexity of FEVAR and BEVAR procedures reveals strong correlations between multiple peri- and postoperative variables. These exposures and risks should be borne in mind when considering treatment of complex abdominal aortic aneurysms as well as long-term clinical outcomes.

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Comparison of outcomes for double fenestrated endovascular aneurysm repair versus triple or quadruple fenestrated endovascular aneurysm repair in the treatment of complex abdominal aortic aneurysms

Cited by 71 publications

References 14 publications

Patient and operating room staff radiation dose during fenestrated/branched endovascular aneurysm repair using premanufactured devices

Patient and operating room staff radiation dose during fenestrated/branched endovascular aneurysm repair using premanufactured devices

Procedural and perioperative results in patients treated with fenestrated endovascular aneurysm repair planned by automated software in a physician-sponsored investigational device exemption trial of physician-modified endografts

Correlations Between Branch Vessel Catheterization and Procedural Complexity in Fenestrated and Branched Endovascular Aneurysm Repair

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