Role of historical and procedural staging during elective fenestrated and branched endovascular treatment of extensive thoracoabdominal aortic aneurysms

Baccani, Luigi; Bertoglio, Luca; Chiesa, Roberto; Faggioli, Gianluca; Fargion, Aaron; Fenelli, Cecilia; Gallitto, Enrico; Gargiulo, Mauro; Isernia, Giacomo; Lenti, Massimo; Antonino, Logiacco; Kahlberg, Andrea; Mascoli, Chiara; Melissano, Germano; Melloni, Andrea; Pini, Rodolfo; Pratesi, Carlo; Rinaldi, Enrico; Simonte, Gioele; Speziali, Sara

doi:10.1016/j.jvs.2021.11.056

Cited by 15 publications

(8 citation statements)

References 46 publications

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“…7 However, in this case, a double transaxillary surgical access would have been required for procedural staging, with a higher risk of stroke. Therefore, we relied on the protective role of the historical staging considering the previous multiple aortic surgeries of this patient 8 and on enhancing the collateral network inflow with the preemptive retrograde surgical revascularization of the only patent hypogastric artery. Prophylactic cerebrospinal fluid drainage was not employed preoperatively but a therapeutic postoperative placement was considered as a bailout procedure in case of new onset of SCI during the postoperative period.…”

Section: Discussionmentioning

confidence: 99%

Transaxillary Tri-Branch Aortic Endovascular Graft Repair of Recurrent Thoracoabdominal Aneurysm With Pararenal Aortic Occlusion

et al. 2022

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The absence of an adequate ileo-femoral access is usually considered an absolute contraindication to fenestrated and branched aortic repairs. Alternative routes and dedicated stent-graft designs have been advocated. Hereby, we describe the case of a 73-year-old man with a recurrent type IV thoracoabdominal aortic aneurysm and complete thrombotic pararenal aortic occlusion treated successfully with a tri-branch custom-made endograft deployed via a transaxillary access.

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Section: Discussionmentioning

confidence: 99%

Transaxillary Tri-Branch Aortic Endovascular Graft Repair of Recurrent Thoracoabdominal Aneurysm With Pararenal Aortic Occlusion

et al. 2022

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“…11 In patients who have undergone an open abdominal repair who progress to a proximal thoracoabdominal aortic aneurysm (TAAA), since, historically, staging of operation has been shown to lower the risk of spinal cord ischemia, need for spinal fluid drainage in these patients is questionable. 12 A recent meta-analysis has also shown that, in patients with a known AAA, 19.2% will have a synchronous or metachronous thoracic aortic aneurysm, with even higher rates (30.7%) in women. 10 Endovascular repair in these patients may simplify the procedure, if a simple thoracic endovascular aneurysm repair (TEVAR) can be offered, or by avoiding open reintervention in the hostile abdomen if a thoracoabdominal repair is needed.…”

Section: Disease Progressions After Abdominal Aortic Aneurysm Repairmentioning

confidence: 99%

Secondary Endovascular Conversions for Failed Open Repair

Melo,

Spath,

Stana

et al. 2023

Aorta (Stamford)

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Late aortic and graft-related complications after open aortic repair are not infrequent and a significant number of them are missed, diagnosed at a very late stage, or present as urgent complications such as aortic rupture or aorto-enteric fistula. Once a late complication is diagnosed and reintervention is necessary, both open and endovascular strategies are possible. Open reintervention is complex and usually associated with very high rates of morbidity and mortality. Endovascular techniques may offer several solutions for these cases, which may be tailored to the patient and specific complication. In this review, we aim to summarize current indications, options, and strategies for endovascular salvage after failed or complicated open surgical repair.

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“…A recent study by Bertoglio and colleagues analyzed 240 patients treated for TAAA by F/BEVAR, where 43 patients had an impaired collateral network, 136 had a historical staging (previous OSR or endovascular procedure with intercostal/lumbar arteries ligation or coverage), and 157 received a staging procedure. The overall rate SCI is also negatively affected by impaired collateral network and bilateral iliac occlusive disease; for this reason, aggressive revascularization of the LSA (preferentially by means of a carotid-subclavian bypass or with custom-made fenestrated-branched proximal TEVAR component) and the IIAs (with preference given to the use of iliac branch devices, bilaterally if needed) should be pursued in order to increase perfusion to the spinal collateral network [ 58 , 59 , 60 , 61 ]. Early lower limb and pelvic reperfusion, with possible use of adjuncts such as pre-loaded guidewire systems, has also been shown to impact the onset and severity of SCI after F/BEVAR [ 62 , 63 , 64 ].…”

Section: Neurologic Complications: Stroke and Spinal Cord Ischemiamentioning

confidence: 99%

Peri-Operative Management of Patients Undergoing Fenestrated-Branched Endovascular Repair for Juxtarenal, Pararenal and Thoracoabdominal Aortic Aneurysms: Preventing, Recognizing and Treating Complications to Improve Clinical Outcomes

Xodo

D’Oria

Mendes

et al. 2022

JPM

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The advent and refinement of complex endovascular techniques in the last two decades has revolutionized the field of vascular surgery. This has allowed an effective minimally invasive treatment of extensive disease involving the pararenal and the thoracoabdominal aorta. Fenestrated-branched EVAR (F/BEVAR) now represents a feasible technical solution to address these complex diseases, moving the proximal sealing zone above the renal-visceral vessels take-off and preserving their patency. The aim of this paper was to provide a narrative review on the peri-operative management of patients undergoing F/BEVAR procedures for juxtarenal abdominal aortic aneurysm (JAAA), pararenal abdominal aortic aneurysm (PRAA) or thoracoabdominal aortic aneurism (TAAA). It will focus on how to prevent, diagnose, and manage the complications ensuing from these complex interventions, in order to improve clinical outcomes. Indeed, F/BEVAR remains a technically, physiologically, and mentally demanding procedure. Intraoperative adverse events often require prolonged or additional procedures and complications may significantly impact a patient’s quality of life, health status, and overall cost of care. The presence of standardized preoperative, perioperative, and postoperative pathways of care, together with surgeons and teams with significant experience in aortic surgery, should be considered as crucial points to improve clinical outcomes. Aggressive prevention, prompt diagnosis and timely rescue of any major adverse events following the procedure remain paramount clinical needs.

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Role of historical and procedural staging during elective fenestrated and branched endovascular treatment of extensive thoracoabdominal aortic aneurysms

Cited by 15 publications

References 46 publications

Transaxillary Tri-Branch Aortic Endovascular Graft Repair of Recurrent Thoracoabdominal Aneurysm With Pararenal Aortic Occlusion

Transaxillary Tri-Branch Aortic Endovascular Graft Repair of Recurrent Thoracoabdominal Aneurysm With Pararenal Aortic Occlusion

Secondary Endovascular Conversions for Failed Open Repair

Peri-Operative Management of Patients Undergoing Fenestrated-Branched Endovascular Repair for Juxtarenal, Pararenal and Thoracoabdominal Aortic Aneurysms: Preventing, Recognizing and Treating Complications to Improve Clinical Outcomes

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