branched endovascular repair for thoracoabdominal ... · branched endovascular aneurysm repair...

Objectives Branched endovascular aneurysm repair (BEVAR) is the endoluminal alternative to conventional surgery for thoraco-abdominal aortic aneurysms (TAAA). The aim of this project was to undertake an evaluation of the use of BEVAR for the treatment of TAAAs in our centre. Branched Endovascular Repair for Thoracoabdominal Aneurysms A Single Centre Midterm Experience 1Santoro G, 1Ormesher DC , 2McWilliams RG, 1Brennan JA, 1Vallabhaneni SR, 1Neequaye S, 1Fisher RK 1 - Department of Vascular Surgery, Royal Liverpool and Broadgreen University Hospitals Trust 2 - Department of Interventional Radiology, Royal Liverpool and Broadgreen University Hospitals Trust Methods A retrospective case series review of all consecutive TAAA patients treated between March 2004 and Decem- ber 2016 with BEVAR. Thoracoabdominal aneurysms with target vessels arising from aneurysm were includ- ed. Patients with pararenal fenestrated repairs were excluded. Results Custom-made devices (Cook®) were deployed in all 33 patients (median age 74; 26 male). The median aneurysm diameter was 70mm (56-94mm). One was for a ruptured aneurysm and 32 were elective. Previous aortic interventions had been performed in 12 patients (37%): 6 open infrarenal repairs, 5 thoracic aneurysms (1 TEVAR, 4 open repairs) and 1 TEVAR for Type B dissection. 24 patients underwent CSF drainage. There were 2 in-hospital deaths. Median LOS was 7.5 days (5-30). Median follow-up was 24 months (range 0-156) during which 21% patients required secondary intervention: 4 for target vessel stent stenosis; 3 for stent dislocations. 14 (42%) patients died during follow-up. 1. Adapting to a total endovascular approach for complex aortic aneurysm repair: Outcomes after fenestrated and branched endovascular aortic repair Budtz-Lilly J, Wanhainenen A, Eriksson J, Mani K. Journal of Vascular Surgery , Volume 66 , Issue 5 , 1349 - 1356 Conclusion BEVAR for TAAA is feasible with risk of signiﬁcant postoperative morbidity, our series shows comparable morbidity and mortality when compared with other published series1. Secondary interventions are required underlining the importance of surveillance. Vessels Stented Number Coeliac 28 SMA 31 Left renal 30 Right renal 27 0.00 0.25 0.50 0.75 1.00 0 50 100 150 Months post-operation Kaplan-Meier survival estimate

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Page 1: Branched Endovascular Repair for Thoracoabdominal ... · Branched endovascular aneurysm repair (BEVAR) is the endoluminal alternative to conventional surgery for thoraco-abdominal

Branched Endovascular Repair for Thoracoabdominal Aneurysms A Single Centre Midterm Experience

1Santoro G, 1Ormesher DC , 2McWilliams RG, 1Brennan JA, 1Vallabhaneni SR, 1Neequaye S, 1Fisher RK1 - Department of Vascular Surgery, Royal Liverpool and Broadgreen University Hospitals Trust

2 - Department of Interventional Radiology, Royal Liverpool and Broadgreen University Hospitals Trust

Methods A retrospective case series review of all consecutive TAAA patients treated between March 2004 and Decem-ber 2016 with BEVAR. Thoracoabdominal aneurysms with target vessels arising from aneurysm were includ-ed. Patients with pararenal fenestrated repairs were excluded.

ResultsCustom-made devices (Cook®) were deployed in all 33 patients (median age 74; 26 male). The median aneurysm diameter was 70mm (56-94mm). One was for a ruptured aneurysm and 32 were elective. Previous aortic interventions had been performed in 12 patients (37%): 6 open infrarenal repairs, 5 thoracic aneurysms (1 TEVAR, 4 open repairs) and 1 TEVAR for Type B dissection. 24 patients underwent CSF drainage.

There were 2 in-hospital deaths. Median LOS was 7.5 days (5-30). Median follow-up was 24 months (range 0-156) during which 21% patients required secondary intervention: 4 for target vessel stent stenosis; 3 for stent dislocations. 14 (42%) patients died during follow-up.

1. Adapting to a total endovascular approach for complex aortic aneurysm repair: Outcomes after fenestrated and branched endovascular aortic repair Budtz-Lilly J, Wanhainenen A, Eriksson J, Mani K. Journal of Vascular Surgery , Volume 66 , Issue 5 , 1349 - 1356

ConclusionBEVAR for TAAA is feasible with risk of signi�cant postoperative morbidity, our series shows comparable morbidity and mortality when compared with other published series1. Secondary interventions are required underlining the importance of surveillance.

Vessels Stented Number

Coeliac 28

SMA 31

Left renal 30

Right renal 27

0.00

0.25

0.50

0.75

1.00

0 50 100 150Months post-operation

Kaplan-Meier survival estimate