Outcomes of Advanta V12 Covered Stents After Fenestrated Endovascular Aneurysm Repair

Abstract

Purpose: Fenestrated endovascular aneurysm repair (FEVAR) is a well-established endovascular treatment option for pararenal abdominal aortic aneurysms in which balloon-expandable covered stents (BECS) are used to bridge the fenestration to the target vessels. This study presents midterm clinical outcomes and patency rates of the Advanta V12 BECS used as a bridging stent. Methods: All patients treated with FEVAR with at least 1 Advanta V12 BECS were included from 2 large-volume vascular centers between January 2012 and December 2015. Primary endpoints were freedom from all-cause reintervention, and freedom from BECS-associated complications and reintervention. BECS-associated complications included significant stenosis, occlusion, type 3 endoleak, or stent fracture. Secondary endpoints included all-cause mortality in-hospital and during follow-up. Results: This retrospective study included 194 FEVAR patients with a mean age of 72.2±8.0 years. A total of 457 visceral arteries were stented with an Advanta V12 BECS. Median (interquartile range) follow-up time was 24.6 (1.6, 49.9) months. The FEVAR procedure was technically successful in 93% of the patients. Five patients (3%) died in-hospital. Patient survival was 77% (95% CI 69% to 84%) at 3 years. Freedom from all-cause reintervention was 70% (95% CI 61% to 78%) at 3 years, and 33% of all-cause reinterventions were BECS associated. Complications were seen in 24 of 457 Advanta V12 BECSs: type 3 endoleak in 8 BECSs, significant stenosis in 4 BECSs, occlusion in 6 BECSs, and stent fractures in 3 BECSs. A combination of complications occurred in 3 BECSs: type 3 endoleak and stenosis, stent fracture and stenosis, and stent fracture and occlusion. The freedom from BECS-associated complications for Advanta V12 BECSs was 98% (95% CI 96% to 99%) at 1 year and 92% (95% CI 88% to 95%) at 3 years. The freedom from BECS-associated reinterventions was 98% (95% CI 95% to 100%) at 1 year and 94% (95% CI 91% to 97%) at 3 years. Conclusion: The Advanta V12 BECS used as bridging stent in FEVAR showed low complication and reintervention rates at 3 years. A substantial number of FEVAR patients required a reintervention, but most were not BECS related.

In Vitro Geometry Analysis of Fenestrations in Endovascular Aneurysm Repair

“…A substantial proportion of post-FEVAR reinterventions have to be performed to treat BECS-associated complications. 1 , 2 Physicians often need, however, to perform selective angiography of all BECSs during the reintervention procedure to identify whether the BECS is causing the problem. Flare geometry analysis may be helpful to detect BECS-associated complications to plan a reintervention and limiting radiation exposure and contrast use.…”

“…Previous studies reported that 33% to 52% of all reinterventions after FEVAR are performed for complications associated with BECS, such as type 3c endoleak, BECS stenosis, BECS occlusion, or stent fracture. 1 , 2 Detecting the origin of an endoleak after FEVAR can be difficult to appreciate on standard computed tomographic angiography (CTA) scans. Often additional selective angiography is necessary to detect which of the BECS is the source of a BECS-related endoleak of other complications.…”

Three-Dimensional Geometric Analysis of Balloon-Expandable Covered Stents Improves Classification of Complications after Fenestrated Endovascular Aneurysm Repair

“…The dataset of this retrospective study comprised patients treated with FEVAR between January 2012 and April 2021 in the University Medical Center Groningen, the Netherlands, and between January 2012 and December 2015 in the General Hospital, Nuremberg, Germany. The FEVAR-patients treated between January 2012 and December 2015 have been described in a previous study [ 11 ]. All patients underwent primary FEVAR to treat a JAAA or to treat a previous failed EVAR and at least one fenestration had to be stented with an Advanta V12 BECS.…”

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

“…A substantial 115 proportion of post-FEVAR reinterventions have to be performed to treat BECSassociated complications. [13,135] Physicians often need, however, to perform selective angiography of all BECSs during the reintervention procedure to identify whether the BECS is causing the problem. FGA may be helpful to detect BECSassociated complications in order to plan a reintervention and limiting radiation exposure and contrast use.…”

“…Previous studies reported that 33% to 52% of all reinterventions after FEVAR are performed for complications associated with BECS, such as type 3c endoleak, BECS stenosis, BECS occlusion or stent fracture. [13,135] Detecting the origin of an endoleak after FEVAR can be difficult to appreciate on standard CTA scans. Often additional selective angiography is necessary to detect which of the BECS is the source of a BECS-related-endoleak of other complication.…”