Short-term outcomes of inner branches for endovascular repair of complex abdominal and thoracoabdominal aortic aneurysms

Abstract

Objectives To report our early experience using endografts with inner branches for the treatment of complex abdominal aortic aneurysms and thoracoabdominal aortic aneurysms (TAAAs). Methods A retrospective analysis of all patients treated in our institution for complex abdominal aortic aneurysms and TAAAs with custom-made stent grafts consisting of one or more inner branches. Data collected included patients demographics, aortic aneurysm morphology, stent grafts features, perioperative morbidity and mortality and short-term reintervention and mortality rates. Results Twenty-seven patients (18 males, mean age 70 ± 7.1) were included. Indications for surgery included TAAAs (12, 41%) juxtarenal abdominal aortic aneurysms (10, 37%), type 1A endoleaks (4, 15%) and paraanastamotic aneurysms (1, 4%). A total of 90 inner branches were used. Twenty-one (78%) of the stent grafts consisted only of inner branches and six (22%) had a combination of inner branches with either fenestrations or outer branches. Technical success was achieved in 26/27 (96%) of the patients. There was one perioperative mortality. Six patients suffered from major perioperative adverse events. Mean follow-up was seven months (range 1–23). During the follow-up period, four patients (15%) required reinterventions. Branch-related reinterventions were performed in two (7%) patients. No occlusions of inner branches occurred during the follow-up. Conclusions Inner branches in branched endovascular aneurysm repairs offer a feasible option for the treatment of complex abdominal aortic aneurysms and TAAAs. The procedures can be completed with high technical success and with acceptable short-term branch-related reintervention rates. Further follow-up is required to determine the long-term durability of this technology.

Meta-analysis of Comparative Studies Between Self- and Balloon-Expandable Bridging Stent Grafts in Branched Endovascular Aneurysm Repair

“…24 Bridging stent selection is usually based on the discretion of the operator taking into account patient and intraoperative characteristics as well as availability in each department. 24,25,26 This choice has many procedural implications including the number of stents needed, access routes, and profile of access sheaths. The technical and clinical success of BEVAR is not only associated to the main endograft, but also to the bridging stent graft, as TV complications affect the post-operative course and mortality rates.…”

“…8,9 BESGs and SESGs may differ in rigidity, which may account for an inability to absorb the kinetic forces during respiration, and TV angulation and tortuosity. 7,9,10,25 In this analysis, only covered stents were used as bridging stents, while bare metal stents were used only for relining due to stenosis or important angulation remarked intra-operatively. The use of bare metal stents does not seem ideal in case of branched device as the risk for endoleak and intimal proliferation may drive to a higher need for re-intervention during follow-up.…”

Stellenwert der „inner Branches“ in der komplexen endovaskulären Aortenchirurgie

“…Nach einer Beobachtungszeit von 1 Jahr zeigte sich eine Offenheitsrate der mit "inner Branches" versorgten Zielgefäße von 92%. Spätere Studien mit "custommade" "inner-Branch"-Prothesen von JOTEC (Hechingen, Deutschland) zeigten technischen Erfolg in 96-100% der Fälle [15,23]. Die Kriterien für die Auswahl der iBEVAR-Plattform waren in der Studie von Abisi et al die weite Distanz zum Zielgefäß und angulierte aortoiliakale Anatomie für die FEVAR, enges Aortenlumen für die BEVAR, Reduktion der Prothesengesamtlänge im Vergleich zur BEVAR und Typ-IA-Endoleaks nach EVAR.…”

Single-center initial experience with inner-branch complex EVAR in 44 patients

“…Here, the latest configuration available, the inner-branched EVAR (iBEVAR), aimed to overcome these potential limitations ( Figure 1 ). Advantages include increased anatomical suitability in narrow aortas while providing enhanced sealing between the main body and the bridging stents ( 11 , 13 ).…”

“…Recently, a pre-cannulated “off-the-shelf” endograft with four inner branches (E-nside; Artivion, Germany) has become available and enabling iBEVAR solution even for urgent and emergency cases ( 16 , 17 ). Up to now, only 84 cases of iBEVAR procedures ≥4 inner branches have been reported in three small cohort studies ( 11 , 13 , 14 ).…”