Changing Patterns Of Fenestrated And Branched Endovascular Aortic Repair: Single Institution Experience
Dongjin Suh, MD, MS, Victor Hatcher, MD, Mel J. Sharafuddin, MD.
University of iowa, Iowa City, IA, USA.
Objectives: The approach to complex endovascular aortic repair has changed drastically with increasing availability of commercial fenestrated devices. We set forth to examine our utilization patterns of available platforms, as our approach continue to evolve to adapt to the patients' needs.
Methods: All endovascular aortic repairs using fenestrated or branched devices (F/BEVAR) performed at the University of Iowa from 2014 to 2021 for juxtarenal abdominal aortic aneurysm (JR-AAA) and thoracoabdominal aortic aneurysms (TAAA) were reviewed. Outcomes were compared between procedures performed between before and after 2018. Measured outcomes include average number of fenestrations, seal length, fluoroscopy time, estimated blood loss (EBL), length of stay (LOS), number of days spent in intensive care unit (ICU stay).
Results: In both JR-AAA and TAAA, respective average seal zone length significantly increased and average fluoroscopy time significantly decreased after 2018. While number of JR-AAA cases remained steady throughout study period, EBL, ICU stay, and LOS were all decreased after 2018 (Table 1). Also, fixation zones ≥7 was achieved in 83% of the procedures compared to 36% prior to 2018 (p<0.0001) (Figure 1). Additionally, there was a significant increase in number of TAAA performed after 2018 but there was no difference in EBL, ICU stay, and LOS in those performed before 2018 (Figure 2).
| JR-AAA (N=90) | 2014-2017 | 2018-2021 | P |
| Number of Procedures (%) | 46 (51%) | 44 (49%) | 0.88 |
| Fenestrations (N) | 2.9±0.6 | 2.6± 0.9 | 0.03 |
| Suprarenal seal length (mm) | 19.8±6.8 | 26.8±12.0 | 0.003 |
| Fluoroscopy time (min) | 98±82 | 59±27 | 0.024 |
| EBL (ml) | 1013±1875 | 420±411 | 0.05 |
| ICU Stay (days) | 1.5±1.8 | 0.5±1.3 | 0.02 |
| LOS (days) | 4.3±4.0 | 2.4±2.3 | 0.02 |
| TAAA (N=45) | 2014-2017 | 2018-2021 | P |
| Number of Procedures (%) | 14 (31%) | 31 (69%) | 0.0007 |
| Fenestrations (N) | 3.2±0.9 | 3.4±0.8 | 0.5 |
| Infra-celiac seal length (mm) | 25.5±4.9 | 48.3±12.8 | 0.014 |
| Fluoroscopy time (min) | 136±39 | 97±56 | 0.05 |
| EBL (ml) | 1200±780 | 1051±1216 | 0.6 |
| ICU Stay (days) | 3.9±2.6 | 2.9±1.9 | 0.3 |
| LOS (days) | 9.4±6.5 | 6.3±3.9 | 0.2 |
Table 1. Comparison of JR-AAA and TAAA repairs before and after 2018
Conclusions: Single center experience demonstrates continued improvement in endovascular repair of complex aortic aneurysms. JR-AAA repairs performed after 2018 showed significantly improved outcomes and more robust seal metrics. With progressive program maturation, there was a steady increase in number of TAAA repairs overtime. This reflects both continued device enhancements, optimal case planning and increased utilization of surgeon enhancement of commercial endografts.
Back to 2022 ePosters