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Objective
Pararenal abdominal aortic aneurysms (p-AAA) require complex endovascular aortic repair
or open surgical repair with suprarenal clamping. Custom made devices (CMD), including
fenestrated/branched endovascular aortic repair (F/B-EVAR) or off the shelf (OTS)
multibranched devices, are available treatment options. The aim of this study is to
determine the additional healthy aortic coverage using an OTS multibranched endograft
versus CMD for the treatment of p-AAAs.
Methods
This was a retrospective single centre analysis of prospectively collected data. Consecutive
patients with p-AAAs requiring a proximal landing zone above the coeliac artery (CA),
planned and treated with CMDs (Zenith Fenestrated) between January 2017 and December
2021 were included in this study. Treatment with supracoeliac coverage using available
OTS multibranched devices was simulated using available pre-operative images: T-Branch;
E-nside; and TAMBE. Study endpoints included the need for additional proximal aortic
coverage, and the number of the segmental arteries additionally covered from the CA
for OTS devices compared with CMDs.
Results
Eighty three patients with p-AAAs were treated with CMDs (all FEVAR), including juxtarenal
AAAs (n = 46; 56%), suprarenal AAAs (n = 20; 24%), and short neck AAAs (n = 17; 20%). In this study, treatment with 249 (3 × 83) OTS endografts was simulated.
When compared with CMDs, OTS devices required a mean of 74 ± 19 mm of additional proximal
healthy aortic coverage from the CA (CMD: 33 ± 19 mm vs. OTS: 108 ± 6 mm; p ≤ .001), as well as an average sacrifice of 2.5 additional segmental arteries (CMD:
1.3 ± 0.8 vs. OTS: 3.8 ± 0.9; p ≤ .001). In 94% of patients, at least one of the available multibranched endografts
could have been implanted in accordance with instructions for use.
Conclusion
Despite not requiring customisation time, OTS endografts for the treatment of p-AAA
lead to a more extensive healthy aortic coverage, as well as an average sacrifice
of 2.5 additional segmental arteries, in comparison with CMDs. When compared with
OTS devices, CMDs appear to limit the extent of unnecessary aortic coverage and the
theoretical subsequent risk of spinal cord ischaemia.
Keywords
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Article info
Publication history
Accepted:
January 16,
2023
Received in revised form:
October 7,
2022
Received:
May 9,
2022
Publication stage
In Press Accepted ManuscriptFootnotes
☆WHAT THIS PAPER ADDS: This is the first study to report the average need for additional proximal aortic coverage comparing custom made fenestrated devices with off the shelf (OTS) endografts in pararenal abdominal aortic aneurysm repair. Overall, OTS endografts require 74 mm more aortic coverage than custom made fenestrated endografts, with an average sacrifice of 2.5 segmental arteries, and a requirement for longer bridging stents. In elective treatment of pararenal abdominal aortic aneurysms, a customised solution limits the extent of unnecessary aortic coverage and could thus reduce the risk of spinal cord ischaemia.
Identification
Copyright
© 2023 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.
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