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

Abstract

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.

Clinical effect of endovascular repair of complex aortic lesions using optimized Octopus surgery

“…Compared with the classic Octopus technique, the optimized Octopus scheme can provide more stent combination schemes to meet the visceral artery’s anatomical requirements while reducing the gutter endoleak as much as possible. Indeed, in the current research, the optimized Octopus scheme is better than the classic Octopus scheme in terms of operation time and blood loss ( Wang et al, 2023 ).…”

“…To ensure the safety and feasibility of the operation, we chose the optimized Octopus scheme to reduce the operation’s difficulty, the operation time, and the error rate. The average operation time of our operation is 5.3 h. The average operation time of 10 cases of TAAA and pararenal aortic aneurysms treated by Wang et al (2023 ) with the Octopus technique was 7.8 h. The average operation time of 21 cases of TAAA and aortic dissection treated by Dua et al (2019 ) with the Octopus technique was 8 hours. The average operation time of 11 cases of TAAA and aortic dissection treated by Hsu et al (2019 ) with the Octopus technique was 9.4 h. Compared with other people’s data, our average operating time is significantly lower than their operating times.…”

“…The 1-month survival rate was 90.5%, the 6-month survival rate was 88.3%, the 1-year survival rate was 71.4%, and the 3-year survival rate was 52.1%. Wang et al (2023 ) reported 10 cases of TAAA and pararenal aortic aneurysms treated with the Octopus technique from May 2016 to May 2019. There were no perioperative deaths.…”

Editorial: Aortic diseases involving visceral artery: clinical therapeutic management and related basic research

“…The joint use covered stent graft and overlapped bare stents in the visceral artery segment demonstrated favorable mid-term clinical outcomes in type V TAAAs ( 5 ). Using of bifurcated abdominal aortic stent graft main body and docking two or three parallel covered stents in the short limb for the reconstruction of visceral arteries, known as “Octopus” technique, demonstrated promising mid-term outcomes for treating ruptured and symptomatic TAAAs ( 6 ).…”