The Impact of Target Vessel Anatomy and Bridging Stent Geometry on Branched Endovascular Aortic Repair Outcomes

Daniel Becker; Laura Sikman; Ahmed Ali; Carlota F Prendes; Jan Stana; Nikolaos Tsilimparis

doi:10.1016/j.ejvs.2024.04.028

The Impact of Target Vessel Anatomy and Bridging Stent Geometry on Branched Endovascular Aortic Repair Outcomes

Eur J Vasc Endovasc Surg. 2024 Apr 27:S1078-5884(24)00364-2. doi: 10.1016/j.ejvs.2024.04.028. Online ahead of print.

Authors

Daniel Becker¹, Laura Sikman¹, Ahmed Ali², Carlota F Prendes¹, Jan Stana¹, Nikolaos Tsilimparis³

Affiliations

¹ Department of Vascular Surgery, University Hospital, LMU Munich, Munich, Germany.
² Department of Vascular Surgery, University Hospital, LMU Munich, Munich, Germany; Department of Vascular Surgery, Cardiovascular and Vascular Surgery Center, University Hospital, Mansoura University, Mansoura, Egypt.
³ Department of Vascular Surgery, University Hospital, LMU Munich, Munich, Germany. Electronic address: Nikolaos.Tsilimparis@med.uni-muenchen.de.

PMID: 38685310
DOI: 10.1016/j.ejvs.2024.04.028

Abstract

Objective: This study aimed to evaluate the impact of target vessel anatomy and bridging stent geometry on target vessel instability in branched endovascular aortic repair (b-EVAR).

Methods: This retrospective, single centre cohort study included all consecutive b-EVARs performed between September 2018 and December 2022 for thoracoabdominal (TAAA) or complex abdominal aortic aneurysms (CAAA). The primary endpoints were target vessel instability and related re-interventions at 12 months. Secondary endpoints were 30 day results, including target vessel instability and re-interventions. Target vessel instability analysis consisted of assessment of target vessel anatomy, including diameter, aortic trunk to branch angle, and tortuosity. Post-operative parameters included change of clock position/horizontal misalignment, bridging length (gap), sealing length, tortuosity, post-stenting angle, and oversizing ratio.

Results: A total of 69 patients (TAAA: n = 56, 81%; CAAA: n = 13, 19%) and 271 (133 visceral and 138 renal) target vessels were included. Cumulative incidence of target vessel instability was 4.8%, 6.4%, and 7.9% at one year, two years, and three years, respectively. In the renal target vessel group, vessel diameter ≤ 4 mm (hazard ratio [HR] 1.28, 95% confidence interval [CI] 1.116 - 2.54; p = .022) and a bridging length ≥ 25 mm (HR 1.320, 95% CI 1.066 - 1.636; p = .011) were associated to increased target vessel instability. In visceral vessels, a change in clock position/horizontal misalignment ≥ 70 minutes (HR 1.072, 95% CI 1.026 - 1.121; p = .002) showed a significant association with target vessel instability.

Conclusion: Target vessel diameter, bridging length (gap), and horizontal misalignment seemed to be associated with adverse target vessel outcomes. This may be solved with more customised endograft solutions to reduce the negative impact of the latter parameter.

Keywords: Branched stent grafts; Complex abdominal aortic pathologies; Target vessel instability; Thoracoabdominal pathologies.