Early Experience with the Octopus Endovascular Strategy in the Management of Thoracoabdominal Aneurysms

Dua, Anahita; Lavingia, Kedar S.; Deslarzes-Dubuis, Céline; Dake, Michael D.; Lee, Jason T.

doi:10.1016/j.avsg.2019.05.043

Cited by 8 publications

(13 citation statements)

References 16 publications

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“…Since then, a few reports have documented promising results by using this attractive technique to treat TAAA and PRAAA. 8–11 Wooster et al 8 reported treatment for 8 TAAA using the “Octopus” technique, describing 2 perioperative deaths (1 died of bowel ischemia due to SMA endograft occlusion) and 1 SCI. Hsu et al 11 reported the “Octopus” technique treatment for 11 TAAA and aortic dissections, demonstrating 89.7% (35/39) technique success rate of target vessels stent placement, 45.5% major complication rate (5/11, including 3 deaths, 1 permanent paraplegia, and 1 temporary paraplegia), and 89.3% (25/28) primary branch patency rate.…”

Section: Discussionmentioning

confidence: 99%

“…Hsu et al 11 reported the “Octopus” technique treatment for 11 TAAA and aortic dissections, demonstrating 89.7% (35/39) technique success rate of target vessels stent placement, 45.5% major complication rate (5/11, including 3 deaths, 1 permanent paraplegia, and 1 temporary paraplegia), and 89.3% (25/28) primary branch patency rate. Dua et al 10 reported the “Octopus” technique treatment for TAAA and aortic dissection in 21 cases, documenting 93.8% primary branch patency rate, 14.3% in-hospital mortality (3/21, including 1 died of bowel ischemia due to SMA occlusion), 19% paraplegia rate, 19.1% gutter leak rate, 24% acute kidney injury, 19% prolonged ventilation, and 4.8% bowel ischemia. In 2018, our team first reported successful treatment for a ruptured type V TAAA using the “Octopus” technique (Case 1).…”

Section: Discussionmentioning

confidence: 99%

“…Despite the gutter space has been well studied, 18 gutter leak was common in the “Octopus” procedures, 8,10,11 which might lead to aneurysm growth and threaten the long-term durability of the novel technique, especially in ruptured scenarios. Although better attachment and expansion of the endografts can be achieved by post balloon dilatation, the gutter size can be even worse after post ballooning, because the cylindrical shape of balloons can change the initial shapes of endografts.…”

Section: Discussionmentioning

confidence: 99%

“…Temporary aneurysm sac perfusion with staged “Octopus” procedure could serve as spinal cord perfusion, but also carries risk of aneurysm rupture and endograft migration. 10 In the current study, all of the cases were performed in one stage. Several measures were taken to prevent SCI.…”

Section: Discussionmentioning

confidence: 99%

“…Since first reported by Kasirajan K, 7 promising outcomes have been demonstrated by several reports of using this attractive technique to treat complex TAAA. [8][9][10][11] However, the effectiveness and safety of this novel technique in aneurysm ruptured scenarios need to be investigated. In the current study, we present the midterm clinical outcomes of the "Octopus" technique treatment for ruptured or symptomatic TAAAs and PRAAAs.…”

Section: Introductionmentioning

confidence: 99%

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Endovascular Treatment of Ruptured or Symptomatic Thoracoabdominal and Pararenal Aortic Aneurysms Using Octopus Endograft Technique: Mid-Term Clinical Outcomes

et al. 2022

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Objective: To evaluate the effectiveness and safety of using off-the-shelf “Octopus” technique to treat ruptured or symptomatic thoracoabdominal aortic aneurysm (TAAA) and pararenal abdominal aortic aneurysm (PRAAA). Methods and Results: All cases who underwent “Octopus” technique from May 2016 to May 2019 at our center were retrospectively analyzed. A total of 10 cases (8 males) were included. The mean age was 54.5±14.2 years (range: 31–80 years). Eight cases presented as aneurysm rupture or impending rupture accepted emergency repair. Technical success, defined by placement of all endografts as planned, was achieved in all cases. A total of 30 target visceral branches were successfully cannulated, 9 celiac arteries were covered intentionally. Intraoperative endoleak was observed in 6 patients, all of them were gutter leak. During hospital stay, there was no death, no side branch occlusion or spinal cord ischemia. Median follow-up was 30 months (range: 12–50 months). One patient died of lung cancer at 14-month follow-up. There was no secondary endoleak. The primary endoleak were found spontaneously resolved in 3 cases at 7 days, 3-month, and 1-year imaging. One persistent endoleak totally resolved after sealing of gutter spaces at 4-month follow-up. The other 2 persistent endoleak decreased during follow-up, which are still under observation. The branch patency rate was 90.3% (28/31). All the 3 occluded branches were renal arteries. Branch occlusion occurred in 2 cases at 1-month follow-up and 1 case at 2-year follow-up, but renal insufficiency was not observed in these cases. Obvious aneurysm sac shrinkage (≥5 mm) was observed in all cases. The aneurysm size shrunk from 7.6±1.9 to 5.5±1.4 cm. No spinal cord ischemia occurred during follow-up. Conclusion: Treatment of ruptured TAAA and PRAAA with “Octopus” technique is feasible and safe for high surgical risk patients in the absence of fenestrated and branched devices. The long-term clinical outcomes needed to be investigated.

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