Urgent and emergent repair of complex aortic aneurysms using an off-the-shelf branched device

Frontiers in Cardiovascular Medicine

Cardiovascular Medicine

Katarzyna Jama¹  Tomasz Jakimowicz¹  Petroula Nana²  Giuseppe Panuccio²  Jose I. Torrealba²  Konstantinos Spanos²  Tilo Kölbel²  Fiona Rohlffs² 

[1] Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland;German Aortic Center, Department of Vascular Medicine, University Heart and Vascular Center UKE Hamburg, Hamburg, Germany;

关键词: urgent;    ruptured;    symptomatic;    complex endovascular repair;    branched devices;    off-theshelf;   

DOI  :  10.3389/fcvm.2023.1277459

 received in 2023-08-14, accepted in 2023-09-11,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionEndovascular repair using off-the-shelf endografts is a viable solution in patients with ruptured or symptomatic complex aortic aneurysms. This analysis aimed to present the peri-operative and follow-up outcomes in urgent and emergent cases managed with the t-Branch multibranched thoracoabdominal endograft.MethodsProspectively collected data from all consecutive urgent and emergent cases managed in two aortic centers between January 1st, 2014, to November 30th, 2022, using the t-Branch device (Cook Medical Inc., Bjaeverskov, Denmark) were analyzed. Patients presenting with ruptured aortic complex aneurysms were characterized as emergent and patients with aneurysms >90 mm of diameter, or symptomatic aneurysms were characterized as urgent. Technical success, 30-day mortality, major adverse events (MAE) and spinal cord ischemia (SCI) rates were assessed.Results225 patients (36.5% females, 72.5 ± 2.8 years) were included; 73.0% were urgent. The mean aneurysm diameter was 109 ± 3.9 mm and 44.4% were type I–III TAAAs. Females (p = .03), para-renal aneurysms (p = .02) and ASA score IV (p < .001) were more common in emergent cases. Technical success was 97.8%. Thirty-day mortality and MAE rates were 17.8% and 30.6%, respectively. SCI rate was 14.7%, (4.8% paraplegia rate) with 22.2% of patients receiving prophylactic cerebrospinal drainage. Thirty-day mortality (13.3% vs. 26.7%, p = .04) and MAE (26.0% vs. 43.0%, p = .02) were more common among emergent cases while technical success (97.6% vs. 98.3%, p = .9), and SCI (13.3% vs. 18.3%, p = .4) were similar. Survival at 12-months was 83.5% (SE 5.9%) for the urgent and 77.1% (SE 8.2%) for the emergent group (log rank, p = 0.96).ConclusionT-Branch represents an effective and safe solution for the management of urgent and emergent cases with complex aortic aneurysms, with high technical success, promising early mortality and SCI rates.

【 授权许可】

Unknown   
© 2023 Nana, Spanos, Jakimowicz, Torrealba, Jama, Panuccio, Rohlffs and Kölbel.