Identification of optimal device combinations for the chimney endovascular aneurysm repair technique within the PERICLES registry

The ideal stent combination for chimney endovascular aneurysm repair remains undetermined. Therefore, we sought to identify optimal aortic and chimney stent combinations that are associated with the best outcomes by analyzing the worldwide collected experience in the PERformance of chImney technique...

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Published in:Journal of vascular surgery 2018-07, Vol.68 (1), p.24-35
Main Authors: Scali, Salvatore T., Beck, Adam W., Torsello, Giovanni, Lachat, Mario, Kubilis, Paul, Veith, Frank J., Lee, Jason T., Donas, Konstantinos P., Dalman, Ronald L., Tran, Kenneth, Lee, Jason, Pecoraro, Felice, Bisdas, Theodosios, Seifert, Sven, Esche, Mirko, Gasparini, Daniele, Frigatti, Paolo, Adovasio, Roberto, Mucelli, Fabio Pozzi, Damrauer, Scott M., Woo, Edward Y., Minion, David, Salenius, Juha, Suominen, Velipekka, Mangialardi, Nicola, Ronchey, Sonia, Fazzini, Stefano, Mestres, Gaspar, Riambau, Vincent, Mosquera, Nilo J.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Alloys
Aortic Aneurysm, Abdominal - diagnostic imaging
Aortic Aneurysm, Abdominal - mortality
Aortic Aneurysm, Abdominal - surgery
Aortic Aneurysm, Thoracic - diagnostic imaging
Aortic Aneurysm, Thoracic - mortality
Aortic Aneurysm, Thoracic - surgery
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation - adverse effects
Blood Vessel Prosthesis Implantation - instrumentation
Blood Vessel Prosthesis Implantation - methods
Blood Vessel Prosthesis Implantation - mortality
Comorbidity
Disease-Free Survival
Endoleak - etiology
Endovascular Procedures - adverse effects
Endovascular Procedures - instrumentation
Endovascular Procedures - methods
Endovascular Procedures - mortality
Europe
Female
Graft Occlusion, Vascular - etiology
Hospitals, High-Volume
Hospitals, Low-Volume
Humans
Male
Multivariate Analysis
Odds Ratio
Polyesters
Polytetrafluoroethylene
Proportional Hazards Models
Prosthesis Design
Registries
Retrospective Studies
Risk Factors
Stainless Steel
Stents
Time Factors
Treatment Outcome
United States
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Summary:The ideal stent combination for chimney endovascular aneurysm repair remains undetermined. Therefore, we sought to identify optimal aortic and chimney stent combinations that are associated with the best outcomes by analyzing the worldwide collected experience in the PERformance of chImney technique for the treatment of Complex aortic pathoLogiES (PERICLES) registry. The PERICLES registry was reviewed for patients with pararenal aortic disease electively treated from 2008 to 2014. Eleven different aortic devices were identified with three distinct subgroups: group A (n = 224), nitinol/polyester; group B (n = 105), stainless steel/polyester; and group C (n = 69), nitinol/expanded polytetrafluoroethylene. The various chimney stent subtypes included the balloon-expandable covered stent (BECS), self-expanding covered stent, and bare-metal stent. Deidentified aortic and chimney device combinations were compared for risk of chimney occlusion, type IA endoleak, and survival. Effects of high-volume centers (>100 cases), use of an internal lining chimney stent, number of chimney stents, and number of chimney stent subtypes deployed were also considered. We considered demographics, comorbidities, and aortic anatomic features as potential confounders in all models. The 1- and 3-year freedom from BECS chimney occlusion was not different between groups (group A, 96% ± 2% and 87% ± 5%; groups B and C, 93% ± 3% and 76% ± 10%; Cox model, P = .33). Similarly, when non-BECS chimney stents were used, no difference in occlusion risk was noted for the three aortic device groupings; however, group C patients receiving BECS did have a trend toward higher occlusion risk relative to group C patients not receiving a BECS chimney stent (hazard ratio [HR], 4.0; 95% confidence interval [CI], 0.85-18.84; P = .08). Patients receiving multiple chimney stents, irrespective of stent subtype, had a 1.8-fold increased risk of occlusion for each additional stent (HR, 1.8; 95% CI, 1.2-2.9; P = .01). Use of a bare-metal endolining stent doubled the occlusion hazard (HR, 2.1; 95% CI, 1.0-4.5; P = .05). Risk of type IA endoleak (intraoperatively and postoperatively) did not significantly differ for the aortic devices with BECS use; however, group C patients had higher risk relative to groups A/B without BECS (C vs B: odds ratio [OR], 3.2 [95% CI, 1-11; P = .05]; C vs A/B: OR, 2.4 [95% CI, 0.9-6.4; P = .08]). Patients treated at high-volume centers had significantly lower odds for development of t
ISSN:0741-5214
1097-6809
DOI:10.1016/j.jvs.2017.10.080