Fenestrated Endovascular Abdominal Aneurysm (F-EVAR) Repair Using A Portable C-arm Without Fusion Technology- A Single Center Experience
Amandeep Juneja, MD, Jonathan Schor, MD, Kuldeep Singh, MD, Jonathan Dietch, MD, Saqib Zia, MBBS.
Staten Island University hospital, staten island, NY, USA.
Objective - Most centers performing F-EVAR use hybrid rooms with fusion technology for mapping. We present our experience of successfully performing F-EVAR using portable C-arm. Methods - Data was collected from a prospectively maintained F-EVAR database at our institute from January 2016 to September 2018. Primary endpoint was technical success and secondary outcomes were short and midterm clinical success as defined by the SVS reporting standards, blood loss, radiation dose, operative time, post-operative endoleaks, endograft patency and complications.Results - We performed 11 F-EVARs in 5(45.5%) males and 7(64.5%) females with mean age of 75 + 8 years. All procedures were performed under general anesthesia using OEC 9900 Elite Mobile C-arm (© 2018 General Electric Company) without the use of fusion technology. Three patients had planned open access procedures, one unilateral iliofemoral and two bilateral iliofemoral bypasses. Mean aneurysm diameter treated was 5.5+1.1cm. Technical success was achieved in all 11 cases. Mean procedure time was 301+167 minutes with mean blood loss 361+233 mL, mean fluoroscopy time 44+31 minutes and mean contrast volume 152+58 mL. Mean number of visceral vessels stented was 2+1. No patients required intra operative transfusion. Mean length of stay was 5+2 days and mean follow up was 7.5+6.5 months. Thirty-day clinical success was achieved in 10(90.0%) cases whereas six-month clinical success was achieved in 7(77.7%) patients. Branch vessel patency at 30 days and 6 months was 11(100%) and 9(81.8%) respectively and primary endograft patency was 100% (11) at 6 months. We had no perioperative mortality or major adverse cardiac event (MACE) at 30 days. Thirty-day post-operative morbidity included readmission for congestive heart failure in one patient and silent cardiac enzyme elevation in two patients. Three patients (27.2%) had re-interventions performed during the follow up period. Two patients had thrombolysis for renal stent thrombosis resulting in renal insufficiency, defined as increase in creatinine concentration ≥0.5 mg/dL, without the need for dialysis. One Type II endoleak required trans-lumbar embolization. No Type I or Type III endoleaks were identified. Asymptomatic common femoral artery thrombosis was seen on follow up imaging in one patient. Conclusions - F-EVAR can be safely performed using C-arm without the use of fusion technology. Its utility can be expanded to the centers with appropriate skill set but no hybrid technology.
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