ENDOVASCULAR REPAIR OF THORACOABDOMINAL AND PARA-RENAL AORTIC ANEURYSMS WITH FENESTRATED AND BRANCHED STENT-GRAFTS
Autor(a) principal: | |
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Data de Publicação: | 2017 |
Outros Autores: | , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://doi.org/10.48750/acv.47 |
Resumo: | Introdution: Aneurismal disease involving the thoracoabdominal segment adds significant complexity to endovascular aortic repair. Objective: Evaluate institutional experience of a tertiary center in fenestrated and branched aneurysm repair for throracoabdominal or juxtarenal aortic aneurysms Methods: Retrospective analysis of a consecutive series of patients treated by endovascular repair using fenestrated or branched stent grafts between October 2010 and May 2016. Results: Twenty-six patients underwent endovascular repair with fenestrated and/or branched stent grafts (mean age 68±7years; 1 female). Eleven patients had history of previous aortic intervention. Seventeen throracobdominal aneuryms had the following anatomic distribution: Type I: n=1; Type III: n=5; Type IV: n=6 and Type 5: n=5. Additionally nine pararenal aneuryms were treated. Mean maximum aneurym diameter was 72±25mm. There were 3 types of stent graft configuration based on aortic anatomy and aneurysm morphology: 21 custom-made (14 fenestrated and 7 fenestrated/branched) and 5 off-the-shelf multibranched (T-branch). The median number of fenestrations/branches per stent graft was 4(2-4). The total target visceral vessels involved was 88. In 88% another planned endovascular procedure was performed: EVAR n=15; TEVAR n=4 and EVAR+TEVAR n=4. The technical sucess rate was 96% (25/26) (1 case of ostial stenosis of the celiac trunk with unssucessfull catetherization). The 30 day mortality rate was 7,7% (2/26). Spinal cord ischemia occurred in 12% (N=3; acute onset N=1; delayed N=2) There was no difference between the pre- and post-operative (p=0,777). The mean follow-up time was 10±15 months. There were 2 endoleaks, and no late re-interventions nor late aneurismatic ruptures during the follow-up time. Conclusion: Fenestrated/branched devices development allowed the treatment of complex high risk aneurismatic disease in a less invasive manner. These procedures are technically demanding, but safe and effective in prevention of aneurysm rupture in our experience. Despite the relatively low number of patients, our results are in line with other international contemporary endovascular series. |
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ENDOVASCULAR REPAIR OF THORACOABDOMINAL AND PARA-RENAL AORTIC ANEURYSMS WITH FENESTRATED AND BRANCHED STENT-GRAFTSTRATAMENTO ENDOVASCULAR DE ANEURISMAS AÓRTICOS TORACO-ABDOMINAIS OU PARA-RENAIS COM RECURSO A ENDOPRÓTESES FENESTRADAS E/OU RAMIFICADASIntrodution: Aneurismal disease involving the thoracoabdominal segment adds significant complexity to endovascular aortic repair. Objective: Evaluate institutional experience of a tertiary center in fenestrated and branched aneurysm repair for throracoabdominal or juxtarenal aortic aneurysms Methods: Retrospective analysis of a consecutive series of patients treated by endovascular repair using fenestrated or branched stent grafts between October 2010 and May 2016. Results: Twenty-six patients underwent endovascular repair with fenestrated and/or branched stent grafts (mean age 68±7years; 1 female). Eleven patients had history of previous aortic intervention. Seventeen throracobdominal aneuryms had the following anatomic distribution: Type I: n=1; Type III: n=5; Type IV: n=6 and Type 5: n=5. Additionally nine pararenal aneuryms were treated. Mean maximum aneurym diameter was 72±25mm. There were 3 types of stent graft configuration based on aortic anatomy and aneurysm morphology: 21 custom-made (14 fenestrated and 7 fenestrated/branched) and 5 off-the-shelf multibranched (T-branch). The median number of fenestrations/branches per stent graft was 4(2-4). The total target visceral vessels involved was 88. In 88% another planned endovascular procedure was performed: EVAR n=15; TEVAR n=4 and EVAR+TEVAR n=4. The technical sucess rate was 96% (25/26) (1 case of ostial stenosis of the celiac trunk with unssucessfull catetherization). The 30 day mortality rate was 7,7% (2/26). Spinal cord ischemia occurred in 12% (N=3; acute onset N=1; delayed N=2) There was no difference between the pre- and post-operative (p=0,777). The mean follow-up time was 10±15 months. There were 2 endoleaks, and no late re-interventions nor late aneurismatic ruptures during the follow-up time. Conclusion: Fenestrated/branched devices development allowed the treatment of complex high risk aneurismatic disease in a less invasive manner. These procedures are technically demanding, but safe and effective in prevention of aneurysm rupture in our experience. Despite the relatively low number of patients, our results are in line with other international contemporary endovascular series.Introdução: O envolvimento da aorta toraco-abdominal na doença aneurismática acresce significativa complexidade ao seu tratamento endovascular. Objectivo: Avaliação de resultados de uma instituição terciária no tratamento endovascular da patologia aneurismática toraco-abdominal ou para-renal, através do uso de endopróteses fenestradas e/ou ramificadas. Material e Métodos: Análise retrospectiva da série consecutiva de doentes com doença aneurismática selecionados para tratamento endovascular através do uso de endopróteses fenestradas e/ou ramificadas no período de Outubro de 2010 a Maio de 2016. Resultados: 26 doentes foram tratados através do uso de endopróteses fenestradas e/ou ramificadas (idade média 68±7 anos; 1 mulher). Onze doentes (42%) tinham antecedentes de intervenção aórtica prévia. Foram tratados 17 aneurismas toracoabdominais cuja distribuição anatómica foi a seguinte: Tipo I: n=1); Tipo III: n=5; Tipo IV: n=6 e Tipo V: n=5. Foram ainda tratados 9 aneurismas aneurismas para-renais. O diâmetro máximo do saco aneurismático era de 72±25mm. Foram implantadas três tipos de endopróteses Zenith Cook® dependendo da anatomia aórtica e da morfologia do aneurisma: custom-made em 21 casos (14 fenestradas e 7 fenestradas/ramificadas) e off-the-shelf multibranched (T-branch) em 5 casos. A mediana de fenestras/ramos por endoprótese foi de 4 (2-4). O número total de vasos viscerais target foi de 89. Em 88% dos casos foi realizado outro procedimento endovascular programado nomeadamente: EVAR aortobiiliaco n=15, TEVAR n=4 e EVAR+TEVAR n=4. A taxa de sucesso técnico aferida foi de 96% (25/26) com um sucesso técnico de revascularização de ramos viscerais de 88/89 (um caso de incapacidade de cateterização tronco celíaco por estenose óstial). A taxa de mortalidade a 30 dias foi de 7,7% (2/26). Verificou-se uma taxa de isquemia medular em 12% (n=3; precoce n=1, tardia n=2). Não foi encontrada diferença estatisticamente significativa entre creatinina pré e a pós-operatoria (P=0,777). A média de tempo follow-up foi de 10±15 meses, durante o qual se verificaram 2 endoleaks. Não se verificaram re-intervenções tardias nem rupturas aneurismáticas tardias. Conclusão: O desenvolvimento de endoprotéses fenestradas/ramificadas abdominais permitiu expandir o tratamento de patologia aneurismática complexa de elevado risco. Trata-se de uma abordagem terapêutica tecnicamente exigente, mas segura e efectiva na prevenção de ruptura aneurismática com resultados sobreponíveis com séries internacionais contemporâneas.Sociedade Portuguesa de Angiologia e Cirurgia Vascular2017-05-14T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://doi.org/10.48750/acv.47oai:ojs.acvjournal.com:article/47Angiologia e Cirurgia Vascular; Vol. 13 No. 1 (2017): March; 14-22Angiologia e Cirurgia Vascular; Vol. 13 N.º 1 (2017): Março; 14-222183-00961646-706Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttp://acvjournal.com/index.php/acv/article/view/47https://doi.org/10.48750/acv.47http://acvjournal.com/index.php/acv/article/view/47/36Copyright (c) 2017 Angiologia e Cirurgia Vascularinfo:eu-repo/semantics/openAccessQuintas, A.Albuquerque e Castro, J.Aragão Morais, J.Bastos Gonçalves, F.Ferreira, R.Vasconcelos, L.Alves, G.Abreu, R.Camacho, N.Catarino, J.Ferreira, M. E.Mota Capitão, L.2022-05-23T15:09:59Zoai:ojs.acvjournal.com:article/47Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T14:57:27.729700Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
ENDOVASCULAR REPAIR OF THORACOABDOMINAL AND PARA-RENAL AORTIC ANEURYSMS WITH FENESTRATED AND BRANCHED STENT-GRAFTS TRATAMENTO ENDOVASCULAR DE ANEURISMAS AÓRTICOS TORACO-ABDOMINAIS OU PARA-RENAIS COM RECURSO A ENDOPRÓTESES FENESTRADAS E/OU RAMIFICADAS |
title |
ENDOVASCULAR REPAIR OF THORACOABDOMINAL AND PARA-RENAL AORTIC ANEURYSMS WITH FENESTRATED AND BRANCHED STENT-GRAFTS |
spellingShingle |
ENDOVASCULAR REPAIR OF THORACOABDOMINAL AND PARA-RENAL AORTIC ANEURYSMS WITH FENESTRATED AND BRANCHED STENT-GRAFTS Quintas, A. |
title_short |
ENDOVASCULAR REPAIR OF THORACOABDOMINAL AND PARA-RENAL AORTIC ANEURYSMS WITH FENESTRATED AND BRANCHED STENT-GRAFTS |
title_full |
ENDOVASCULAR REPAIR OF THORACOABDOMINAL AND PARA-RENAL AORTIC ANEURYSMS WITH FENESTRATED AND BRANCHED STENT-GRAFTS |
title_fullStr |
ENDOVASCULAR REPAIR OF THORACOABDOMINAL AND PARA-RENAL AORTIC ANEURYSMS WITH FENESTRATED AND BRANCHED STENT-GRAFTS |
title_full_unstemmed |
ENDOVASCULAR REPAIR OF THORACOABDOMINAL AND PARA-RENAL AORTIC ANEURYSMS WITH FENESTRATED AND BRANCHED STENT-GRAFTS |
title_sort |
ENDOVASCULAR REPAIR OF THORACOABDOMINAL AND PARA-RENAL AORTIC ANEURYSMS WITH FENESTRATED AND BRANCHED STENT-GRAFTS |
author |
Quintas, A. |
author_facet |
Quintas, A. Albuquerque e Castro, J. Aragão Morais, J. Bastos Gonçalves, F. Ferreira, R. Vasconcelos, L. Alves, G. Abreu, R. Camacho, N. Catarino, J. Ferreira, M. E. Mota Capitão, L. |
author_role |
author |
author2 |
Albuquerque e Castro, J. Aragão Morais, J. Bastos Gonçalves, F. Ferreira, R. Vasconcelos, L. Alves, G. Abreu, R. Camacho, N. Catarino, J. Ferreira, M. E. Mota Capitão, L. |
author2_role |
author author author author author author author author author author author |
dc.contributor.author.fl_str_mv |
Quintas, A. Albuquerque e Castro, J. Aragão Morais, J. Bastos Gonçalves, F. Ferreira, R. Vasconcelos, L. Alves, G. Abreu, R. Camacho, N. Catarino, J. Ferreira, M. E. Mota Capitão, L. |
description |
Introdution: Aneurismal disease involving the thoracoabdominal segment adds significant complexity to endovascular aortic repair. Objective: Evaluate institutional experience of a tertiary center in fenestrated and branched aneurysm repair for throracoabdominal or juxtarenal aortic aneurysms Methods: Retrospective analysis of a consecutive series of patients treated by endovascular repair using fenestrated or branched stent grafts between October 2010 and May 2016. Results: Twenty-six patients underwent endovascular repair with fenestrated and/or branched stent grafts (mean age 68±7years; 1 female). Eleven patients had history of previous aortic intervention. Seventeen throracobdominal aneuryms had the following anatomic distribution: Type I: n=1; Type III: n=5; Type IV: n=6 and Type 5: n=5. Additionally nine pararenal aneuryms were treated. Mean maximum aneurym diameter was 72±25mm. There were 3 types of stent graft configuration based on aortic anatomy and aneurysm morphology: 21 custom-made (14 fenestrated and 7 fenestrated/branched) and 5 off-the-shelf multibranched (T-branch). The median number of fenestrations/branches per stent graft was 4(2-4). The total target visceral vessels involved was 88. In 88% another planned endovascular procedure was performed: EVAR n=15; TEVAR n=4 and EVAR+TEVAR n=4. The technical sucess rate was 96% (25/26) (1 case of ostial stenosis of the celiac trunk with unssucessfull catetherization). The 30 day mortality rate was 7,7% (2/26). Spinal cord ischemia occurred in 12% (N=3; acute onset N=1; delayed N=2) There was no difference between the pre- and post-operative (p=0,777). The mean follow-up time was 10±15 months. There were 2 endoleaks, and no late re-interventions nor late aneurismatic ruptures during the follow-up time. Conclusion: Fenestrated/branched devices development allowed the treatment of complex high risk aneurismatic disease in a less invasive manner. These procedures are technically demanding, but safe and effective in prevention of aneurysm rupture in our experience. Despite the relatively low number of patients, our results are in line with other international contemporary endovascular series. |
publishDate |
2017 |
dc.date.none.fl_str_mv |
2017-05-14T00:00:00Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://doi.org/10.48750/acv.47 oai:ojs.acvjournal.com:article/47 |
url |
https://doi.org/10.48750/acv.47 |
identifier_str_mv |
oai:ojs.acvjournal.com:article/47 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
http://acvjournal.com/index.php/acv/article/view/47 https://doi.org/10.48750/acv.47 http://acvjournal.com/index.php/acv/article/view/47/36 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2017 Angiologia e Cirurgia Vascular info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2017 Angiologia e Cirurgia Vascular |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
publisher.none.fl_str_mv |
Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
dc.source.none.fl_str_mv |
Angiologia e Cirurgia Vascular; Vol. 13 No. 1 (2017): March; 14-22 Angiologia e Cirurgia Vascular; Vol. 13 N.º 1 (2017): Março; 14-22 2183-0096 1646-706X reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
instname_str |
Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
repository.mail.fl_str_mv |
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1799129848624447488 |