Complex Aortic Interventions Can Be Safely Introduced to the Clinical Practice by Physicians Skilled in Basic Endovascular Techniques

Abstract

Our purpose was to evaluate the risk associated with the learning curve of starting a complex aortic programme in an Eastern European country. A retrospective study was conducted involving the initial 20 patients (16 males, mean age: 65 ± 11 years) undergoing fenestrated/branched endovascular aortic repair in a single centre. Demographic, anatomical, procedural, and postoperative variables were collected. Our elective patient cohort consisted of 9 pararenal aneurysms (45%) and 11 thoracoabdominal aortic aneurysms (55%), with the latter including 4 chronic dissection cases (20%). A total of 71 branch vessels were incorporated (3.5 ± 0.9 per patient). The per vessel technical success rate was 100%. In-hospital mortality was 5% (1/20). At an average follow-up of 14 ± 22 months, the primary clinical success rate was 45% (9/20) and the secondary clinical success was achieved in 75% of cases (15/20). All-cause mortality at 14 months was 20% (4/20; aortic related: 1/20, 5%). Four bridging stent occlusions were found (5.6%). Mortality and reintervention rates were comparable to the initial results of high-volume centres, while the complexity of our cases and the per vessel technical success rate was comparable to the values reported as late experience. The morbidity of the learning curve could be decreased if operators are skilled in basic endovascular procedures.

The impact of increasing saline flush volume to reduce the amount of residual air in the delivery system of aortic prostheses – a randomized controlled trial

“…Exclusion criteria were compromised proximal or distal landing zone requiring either fenestrated EVAR, the use of endoanchors, an additional graft component besides the main body, ipsilateral limb and the contralateral limb or an iliac branch device or surgeons' disagreement with all three graft types due to their former experiences. All procedures were performed by the same, experienced endovascular team [16][17][18][19] in the same hybrid operating room, equipped with GE Discovery IGS 730 (GE HealthCare, Chicago, IL, USA), a xed-mount imaging system. The scrub nurse performed deairing of the contrast media injector and just prior to insertion, was asked to ush the delivery system with the requested amount of normal saline through the ush port with a 20 ml syringe.…”