Reporting standards for endovascular aortic repair of aneurysms involving the renal-mesenteric arteries

Oderich, Gustavo S.; Forbes, Thomas L.; Chaer, Rabih A.; Davies, Mark G.; Lindsay, Thomas F.; Mastracci, Tara M.; Singh, Michael J.; Timaran, Carlos H.; Woo, Edward Y.

doi:10.1016/j.jvs.2020.06.011

Cited by 333 publications

(160 citation statements)

References 151 publications

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“…In accordance with the reporting standards of the Society for Vascular Surgery clinical success is defined as successful deployment and implantation of the aortic modular components and side branches, absence of death, aneurysm rupture, graft infection, conversion to open surgical repair, permanent paraplegia, disabling stroke and permanent dialysis. 13 Furthermore, the ongoing primary clinical success was evaluated, which is defined as clinical success with freedom from any unplanned secondary surgical or endovascular procedure targeting the aortic pathology, which was initially treated with the complex endovascular aortic repair.…”

Section: Endpointsmentioning

confidence: 99%

Performance of the Gore VBX Balloon Expandable Endoprosthesis as Bridging Stent-Graft in Branched Endovascular Aortic Repair for Thoracoabdominal Aneurysms

et al. 2021

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Purpose Bridging stent stability is crucial for efficacy and safety of branched aortic endovascular repair (bEVAR) of thoracoabdominal aortic aneurysms (TAAAs). In this study, we assess the performance of the new Viabahn Balloon-Expandable endoprosthesis (VBX) in bEVAR. Based on our learning curve we give recommendations for a safe and effective use of the device. Materials and Methods We prospectively collected the data of patients with TAAAs undergoing bEVAR between December 2017 and December 2019. All patients with implantation of at least 1 VBX stent-graft as bridging stent were included in our single-center analysis. Demographic, comorbidity, and computed tomography angiography (CTA) data of 112 patients were retrospectively evaluated. Primary endpoint was a composite of branch-related technical success and freedom from target vessel instability. Secondary endpoints were clinical and ongoing clinical success. Results Primary endpoint: technical success was achieved in all patients (100%) with a freedom from target vessel instability of 96.3% after a median follow-up of 18 months. Overall mortality was 13.4% (n=15) and 13 patients underwent secondary interventions, 12 of them are still alive and 1 suffered from aneurysm sac expansion, consequently an ongoing clinical success of 75.9% was reached. After modification of the implantation technique during the course of the study by selecting longer stent lengths after accurate estimation of vessel curvature and expected adaptation of the flexible endoskeleton to the specific anatomical conditions, no type Ic endoleaks were observed in the last 70 cases. Conclusions The VBX stent-graft can be safely used as bridging stent for branched thoracoabdominal repair. However, learning curve should be considered to avoid type Ic endoleak and edge stenosis. Based on this experience longer landing zones and 2-step deployment of VBX are useful for successful bridging also of challenging target vessels.

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Section: Endpointsmentioning

confidence: 99%

Performance of the Gore VBX Balloon Expandable Endoprosthesis as Bridging Stent-Graft in Branched Endovascular Aortic Repair for Thoracoabdominal Aneurysms

et al. 2021

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Section: Methodsmentioning

confidence: 99%

“…We used the following periods to define follow-up: short term encompasses the first 30 days to 6 months of follow-up; mid-term refers to 6 months to 5 years; long term denotes more than 5 years. 42 Initial, short-term placement of prosthetic grafts with subsequent revision to a vein graft was defined as a temporizing procedure, and the patency of the vein graft was reported. 43 Imaging studies documenting repair patency, even if stenoses or other issues were identified, were defined as patent.…”

Section: Primary Outcomementioning

confidence: 99%

Patency of arterial repairs from wartime extremity vascular injuries

Haney

Bae

Pugh

et al. 2020

Trauma Surg Acute Care Open

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BackgroundExtremity vascular injury (EVI) causes significant disability in Veterans of the Afghanistan/Iraq conflicts. Advancements in acute trauma care improved survival and decreased amputations. The study of wartime EVI has relied on successful limb salvage as a surrogate for vascular repair. We used imaging studies as a specific measure of arterial repair durability.MethodsService members with EVI were identified using the Department of Defense Trauma Registry and validated by chart abstraction. Inclusion criteria for the arterial patency subgroup included an initial repair attempt with subsequent imaging reports (duplex ultrasound, CT angiography, and angiogram) documenting initial patency.ResultsThe cohort of 527 included 140 Veterans with available imaging studies for 143 arterial repairs; median follow-up from injury time to last available imaging study was 19 months (Q1–Q3: 3–58; range: 1–175). Injury mechanism was predominantly explosions (52%) and gunshot wounds (42%). Of the 143 arterial repairs, 81% were vein grafts. Eight repairs were occluded, replaced or included in extremity amputations. One upper extremity and three transtibial late amputations were performed for chronic pain and poor function averaging 27 months (SD: 4; range: 24–32). Kaplan-Meier analysis estimated patency rates of 99%, 97%, 95%, 91% and 91% at 3, 6, 12, 24, and 36 months, respectively, with similar results for upper and lower extremity repairs. Explosive and gunshot wound injury mechanisms had similar patency rates and upper extremity injuries repaired with vein grafts had increased patency.ConclusionsArterial repair mid-term patency in combat-related extremity injuries is excellent based on imaging studies for 143 repairs. Assertive attempts at acute limb salvage and vascular repair are justified with decisions for amputation versus limb salvage based on the overall condition of the patient and degree of concomitant nerve, orthopedic and soft tissue injuries rather than the presence of arterial injuries.Level of evidenceTherapeutic/care management, level IV.

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“…The report by Oderich et al 4 emphasizes the critical importance of three-dimensional imaging because of its key role in choosing the correct FBEVAR devices (eg, selecting the appropriate landing zones and graft design), guiding the surgery (eg, appropriate working angulations, fusion mask, prediction of technical difficulty), and assessing technical success (eg, completion cone bean computed tomography and postoperative computed tomography). The mastery of threedimensional image manipulation is an essential component of current endovascular surgical training because of the major effects on early and late procedure outcomes (ie, reduced procedure duration, reduced radiation and contrast doses, increased primary technical success, and reduced secondary intervention rates).…”

Section: Imaging In Planning Selection and Trainingmentioning

confidence: 99%

Critical points from the reporting standards for endovascular aortic repair of aneurysms involving the renal-mesenteric arteries

Haulon

Tyrrell

Fabre

2021

Journal of Vascular Surgery

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The U.S. Multicenter Fenestrated/Branched Aortic Research Consortium (ARC) has reported data of unmatched quality concerning complex aortic aneurysm repair with fenestrated and branched endografts (fenestrated/branched-endovascular aortic repair [FBEVAR]). The ARC reports prospective, multicenter, monitored, nonrandomized results collected from physiciansponsored investigational device exemption studies. [1][2][3] To evaluate FBEVAR outcomes, graft designs, bridging stents and then compare them with the results from open surgery and the ARC outcomes, Oderich et al 4 have proposed new reporting standards for complex aneurysms. These reporting standards are in addition to those previously published for reporting EVAR and thoracic EVAR and should be integral to any FBEVAR trial design, including the currently compulsory postmarket studies. We have highlighted and discussed the critical points included in their proposals. 4

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Reporting standards for endovascular aortic repair of aneurysms involving the renal-mesenteric arteries

Cited by 333 publications

References 151 publications

Performance of the Gore VBX Balloon Expandable Endoprosthesis as Bridging Stent-Graft in Branched Endovascular Aortic Repair for Thoracoabdominal Aneurysms

Performance of the Gore VBX Balloon Expandable Endoprosthesis as Bridging Stent-Graft in Branched Endovascular Aortic Repair for Thoracoabdominal Aneurysms

Patency of arterial repairs from wartime extremity vascular injuries

Critical points from the reporting standards for endovascular aortic repair of aneurysms involving the renal-mesenteric arteries

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