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Branched and fenestrated TEVAR for high risk thoracic/ thoracoabdominal aneurysm patients from the Vascular Study Group of New England (VSGNE)
Laura T. Boitano, MD1, Robert T. Lancaster, MD, MPH1, Emel Ergul, MS1, Andres Schanzer, MD2, Mark F. Fillinger, MD3, Christopher J. Kwolek, MD1, Richard P. Cambria, MD1, Virendra I. Patel, MD, MPH1.
1The Massachusetts General Hospital, Boston, MA, USA, 2University of Massachusetts Medical School, Worcester, MA, USA, 3Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
OBJECTIVES:
There is limited multicenter data on use of branched/fenestrated endografts (BR/FEN) for repair of thoracoabdominal aneurysms (TAAA). We report early experience with such devices from a regional quality registry.
METHODS:
Patients from the Vascular Study Group of New England (VSGNE) registry who underwent BR/FEN repair of TAAA (2011 - 2013) were evaluated for clinical and technical features, and early outcomes.
RESULTS:
33 patients underwent BR/FEN. Clinical features included a mean age 75±8, male gender(74%), moderate or severe CKD(44%), h/o smoking(82%), COPD(47%), CAD(38%), unfit for open surgery(62%), prior aortic surgery(29%), and rupture(3%). (TAAA) was the most common indication(56%). All patients were repaired with TEVAR, without open surgical components or conversion. Target artery revascularization with scallops/fenestrations (+/- stents), branches, or sidearm stent grafts were as follows: celiac(93%), SMA(96%), Rt. renal(96%), and Lt. renal(96%). Technical features were length of aortic coverage 21±6cm, OR time 262±68mins, fluoro time 74±27 min, contrast 64±30 ml, and EBL 440±840ml. Technical complications included iliac artery injury(5.9%), and any endoleak(32%) (by type: 1(0%), 2(14%), 3(14%),4 (7.1%)). LOS was 21±70 days (Median= 4d). There were no open surgical conversions. Only one(2.9%) 30day death was observed. Complication included resp. failure(2.4%), and MI(5.9%). No stroke or SCI were observed. At a median of 350 days 2 branch occlusions occurred and 3 patients had died.
CONCLUSIONS:
This early experience with BR/FEN is promising with regards to low mortality, clinical safety, and technical success in a high risk cohort. Continued follow up is necessary to better assess the durability of devices and outcomes in comparison to open repair.
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