P118. Early Results of Physician-Modified inner branched Endovascular Repair for Complex Aortic Aneurysms
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Sapporo Medical University
Sapporo
Japan - Contact Me
Tsuyoshi Shibata is an assistant professor of Cardiovascular Surgery at Sapporo Medical University. His work focuses specifically on revascularization for peripheral artery diseases and physician modified endografts for complex aortic aneurysm (including physician modified inner branched endovascular repair). He earned the 2018 Japan Endovascular Treatment Conference best image award and 2023 JSVS best presentation award.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
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.
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
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.
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
Presentation Duration
PODS will be on display in the exhibit hall for the duration of the meeting during exhibit hall hours. PODS will also be available for viewing on the meeting website. There is no formal presentation associated with your POD, but we encourage you to visit the PODS area during breaks to connect with those viewing.