Standard off-the-shelf versus custom-made multibranched thoracoabdominal aortic stent grafts

Objective The complex aortic branch anatomy in thoracoabdominal aortic aneurysms (TAAAs) and pararenal aortic aneurysms (PRAAs) presents a challenge for endovascular repair. The multibranched endovascular device has durable midterm results with use of a custom branch stent graft (CSG) configuration....

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Published in:Journal of vascular surgery 2016-05, Vol.63 (5), p.1208-1215
Main Authors: Fernandez, Charlene C., BS, Sobel, Julia D., BS, Gasper, Warren J., MD, Vartanian, Shant M., MD, Reilly, Linda M., MD, Chuter, Timothy A.M., MD, Hiramoto, Jade S., MD
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Aortic Aneurysm, Thoracic - diagnostic imaging
Aortic Aneurysm, Thoracic - surgery
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation - adverse effects
Blood Vessel Prosthesis Implantation - instrumentation
Endovascular Procedures - adverse effects
Endovascular Procedures - instrumentation
Female
Humans
Male
Middle Aged
Operative Time
Postoperative Complications - etiology
Prospective Studies
Prosthesis Design
San Francisco
Stents
Surgery
Time Factors
Time-to-Treatment
Treatment Outcome
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Summary:Objective The complex aortic branch anatomy in thoracoabdominal aortic aneurysms (TAAAs) and pararenal aortic aneurysms (PRAAs) presents a challenge for endovascular repair. The multibranched endovascular device has durable midterm results with use of a custom branch stent graft (CSG) configuration. The midterm results with use of the standard branch stent graft (SSG) configuration are unknown, but it has the advantage of off-the-shelf technology. The goal of this study was to compare the midterm outcomes of CSG and SSG multibranched endovascular devices. Methods From July 2005 to September 2014, 133 patients underwent elective endovascular repair of TAAA and PRAA in a prospective trial. Beginning in December 2008, SSGs were used in those with suitable anatomy. Results Fifty patients (mean age, 71 ± 7 years; 11 women [22%]) were treated using SSGs, and 83 patients (mean age, 74 ± 9 years; 22 women [26.5%]) underwent repair using CSGs. The SSG and CSG groups were similar with regard to aneurysm size, aneurysm extent, and medical comorbidities, with the sole exception of lung disease, which was more common in the SSG group. All stent grafts were deployed as intended, with no conversions to open repair. Mean ± standard deviation follow-up (days) was 694 ± 525 for the SSG group and 942 ± 764 for the CSG group ( P  = .045). There were no significant differences in aneurysm-related death, renal failure requiring dialysis, stroke, endoleak, visceral or renal branch occlusion, lower extremity weakness, or reintervention ( P > .05 for each). The volume of contrast material was significantly lower in those with SSGs compared with CSGs ( P  = .016), but there were no significant differences in operative or fluoroscopy times. Time to treatment (days from consent to surgery) was significantly lower in SSG patients compared with CSG patients ( P  = .01). Conclusions For patients with suitable anatomy, the use of SSGs for TAAA and PRAA repair results in significantly shorter wait times to surgery and is as safe, effective, and durable in the midterm compared with CSGs.
ISSN:0741-5214
1097-6809
DOI:10.1016/j.jvs.2015.11.035