Early Results of Physician-Modified inner branched Endovascular Repair for Complex Aortic Aneurysms
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0118
Submission Type:
Abstract Submission
Authors:
Tsuyoshi Shibata (1), Yutaka Iba (1), Kiyomitsu Yasuhara (2), Noriaki Kuwada (3), Yoshiaki Katada (4), Hitoki Hashiguchi (5), Takeshi Uzuka (6), Tomohiro Nakajima (1), Junji Nakazawa (1), Shuhei Miura (1), Ayaka Arihara (1), Keitaro Nakanishi (1), Takakimi Mizuno (1), Kei Mukawa (1), Nobuyoshi Kawaharada (1)
Institutions:
(1) Sapporo Medical University, Sapporo, Japan, (2) Isesaki Municipal Hospital, Isesaki, Japan, (3) Kawasaki Medical School, Kurashiki, Japan, (4) Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan, (5) Hokkaido Prefectural Kitami Hospital, Kitami, Japan, (6) Sunagawa City Medical Center, Sunagawa, Japan
Submitting Author:
Tsuyoshi Shibata
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Sapporo Medical University
Sapporo Medical University
Co-Author(s):
Yutaka Iba
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Sapporo Medical University
Sapporo Medical University
Kiyomitsu Yasuhara
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Isesaki Municipal Hospital
Isesaki Municipal Hospital
Noriaki Kuwada
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Kawasaki Medical School
Kawasaki Medical School
Yoshiaki Katada
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Tokyo Medical University Ibaraki Medical Center
Tokyo Medical University Ibaraki Medical Center
Hitoki Hashiguchi
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Hokkaido Prefectural Kitami Hospital
Hokkaido Prefectural Kitami Hospital
Takeshi Uzuka
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Sunagawa City Medical Center
Sunagawa City Medical Center
Tomohiro Nakajima
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Sapporo Medical University
Sapporo Medical University
Junji Nakazawa
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Sapporo Medical University
Sapporo Medical University
Shuhei Miura
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Sapporo Medical University
Sapporo Medical University
Ayaka Arihara
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Sapporo Medical University
Sapporo Medical University
Keitaro Nakanishi
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Sapporo Medical University
Sapporo Medical University
Takakimi Mizuno
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Sapporo Medical University
Sapporo Medical University
Kei Mukawa
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Sapporo Medical University
Sapporo Medical University
Nobuyoshi Kawaharada
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Sapporo Medical University
Sapporo Medical University
Presenting Author:
Tsuyoshi Shibata
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Abstract:
Objective: Open surgical repair of pararenal aortic aneurysms (PRAAs) or thoracoabdominal aortic aneurysms (TAAAs) in high-surgical-risk patients is associated with significant morbidity and mortality. This study aims to present the early outcomes of physician-modified inner branched endovascular repair (PMiBEVAR) for PRAAs and TAAAs in patients at high surgical risk.
Methods: We conducted a comprehensive review of clinical data and outcomes from consecutive patients treated at six centers with PMiBEVAR for PRAA or TAAA from December 2020 to September 2023. Key endpoints included technical success, 30-day mortality, major adverse events (MAE), patient survival, freedom from aneurysm-related mortality, and freedom from reintervention. Patient eligibility for PMiBEVAR adhered to the following criteria: (1) American Society of Anesthesiologists (ASA) score of ≥ 3 or inapplicability of conventional open repair due to anatomical reasons or comorbidities; and (2) considerable involvement of visceral vessels. Protocol and informed consent were approved by the Institutional Review Boards.
Results: Among the patients, there were 7 PRAAs and 27 TAAAs, involving 82 renal-mesenteric arteries incorporated through 10 fenestrations or 72 inner branches. Seven cases (20.6%) presented with rupture, including five impending rupture. 67.6% of patients had an ASA score of 3 or higher and 58.8% had a history of previous aortic surgery. The technical success rate per patient was 94.1%. Mean operative time was 364.8 min, mean contrast volume was 178.9 ml, and mean fluoroscopy time was 139.5 min. The 30-day mortality rate was 17.6% (6 patients). MAE occurred in 9 patients (26.5%), including acute kidney injury in 3 patients (8.8%), respiratory failure in 3 patients (8.8%), bowel ischemia in one patient (2.9%), and spinal cord injury in 4 patients (11.8%). No type I endoleaks occurred at postoperatively. The mean follow-up was 16.6 months. At 2 years, the survival rate, freedom from aneurysm-related mortality, and freedom from reintervention were 57.7%, 82.4%, and 80.9%, respectively.
Conclusions: PMiBEVAR proves to be a viable approach for treating PRAA or TAAAs in patients at high surgical risk, demonstrating acceptable outcomes at the 2-year mark. This technology enables surgeons to customize surgery to a patient's specific anatomy without geographical restrictions and manufacturing time delays. However, the long-term durability of this approach remains uncertain, necessitating further large-scale and long-term studies.
Methods: We conducted a comprehensive review of clinical data and outcomes from consecutive patients treated at six centers with PMiBEVAR for PRAA or TAAA from December 2020 to September 2023. Key endpoints included technical success, 30-day mortality, major adverse events (MAE), patient survival, freedom from aneurysm-related mortality, and freedom from reintervention. Patient eligibility for PMiBEVAR adhered to the following criteria: (1) American Society of Anesthesiologists (ASA) score of ≥ 3 or inapplicability of conventional open repair due to anatomical reasons or comorbidities; and (2) considerable involvement of visceral vessels. Protocol and informed consent were approved by the Institutional Review Boards.
Results: Among the patients, there were 7 PRAAs and 27 TAAAs, involving 82 renal-mesenteric arteries incorporated through 10 fenestrations or 72 inner branches. Seven cases (20.6%) presented with rupture, including five impending rupture. 67.6% of patients had an ASA score of 3 or higher and 58.8% had a history of previous aortic surgery. The technical success rate per patient was 94.1%. Mean operative time was 364.8 min, mean contrast volume was 178.9 ml, and mean fluoroscopy time was 139.5 min. The 30-day mortality rate was 17.6% (6 patients). MAE occurred in 9 patients (26.5%), including acute kidney injury in 3 patients (8.8%), respiratory failure in 3 patients (8.8%), bowel ischemia in one patient (2.9%), and spinal cord injury in 4 patients (11.8%). No type I endoleaks occurred at postoperatively. The mean follow-up was 16.6 months. At 2 years, the survival rate, freedom from aneurysm-related mortality, and freedom from reintervention were 57.7%, 82.4%, and 80.9%, respectively.
Conclusions: PMiBEVAR proves to be a viable approach for treating PRAA or TAAAs in patients at high surgical risk, demonstrating acceptable outcomes at the 2-year mark. This technology enables surgeons to customize surgery to a patient's specific anatomy without geographical restrictions and manufacturing time delays. However, the long-term durability of this approach remains uncertain, necessitating further large-scale and long-term studies.
Aortic Symposium:
Descending/Thoracoabdominal Aorta
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