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Feasibility And Early Results Of Thoracoabdominal Multibranch Endoprosthesis For Treating Complex Aortic Aneurysms In The Community Setting
Sophia G. Jimenez, MD
1, Carolsun S. Rajan, DO
1, Joe K. Wells, III, MD
2, Kofi B. Quaye, MD
2, Scott A. Seidel, MD
2, Ryan S. Turley, MD
2.
1St. David's South Austin Medical Center, Austin, TX, USA,
2Cardiothoracic and Vascular Surgeons, Austin, TX, USA.
Objectives: Complex endovascular repairs of pararenal abdominal aortic aneurysms (AAA) and type III/IV thoracoabdominal aortic aneurysms (TAAA) have traditionally been performed at large, quaternary academic medical centers. These centers typically have access to FDA-investigational device exemption (IDE) fenestrated grafts or more commonly use 'off-label' physician-modified endografts. The GORE EXCLUDER Thoracoabdominal Multibranch Endoprosthesis (TAMBE), an 'off-the-shelf' graft, offers a new solution for treating complex aortic aneurysms. This study specifically reports results from 13 patients who underwent TAMBE procedures at a large community-based, private practice.
Methods:Data from 13 patients between January 2020 and August 20224 were prospectively collected. Inclusion criteria required patients to have complex aortic aneurysms involving the visceral vessels, suitable for TAMBE device intervention. Descriptive statistics were utilized to summarize the data, with continuous variables reported as medians with interquartile ranges (IQR) and categorical variables as percentages with standard errors.
Results: Median patient age was 74 and 77% were male. The cohort included 8 pararenal AAA, 2 type III TAAA, and 3 type IV TAAA. Median Maximum aneurysm diameter was 55 (50-66) mm. Technical success was achieved in 100% of the cases. Median (IQR) operative time was 397 (383-421) minutes and median fluoroscopy time was 51 (44-66) minutes. The median total radiation dose was 602 (355-917) Gy/cm
2. Fifty one vessel branches were stented successfully with no endoleaks at the conclusion of the procedure. One renal branch was intentionally plugged as the outflow kidney was atrophic and fed by a renal artery too small to safely stent. No endoleaks and no deaths occurred in 30 days and median (IQR) length of hospitalization was 5.5 (3.75-9.25) days.
Conclusions: The findings suggest that the GORE EXCLUDER TAMBE device is both safe and effective for use in community hospital settings. This study supports the broader adoption of TAMBE in non-academic environments, potentially expanding access to advanced aortic aneurysm treatments within community hospitals.
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