Initial Clinical Experience With a New Conformable Abdominal Aortic Endograft: Aortic Neck Coverage and Curvature Analysis in Challenging Aortic Necks

Alice Finotello; Richte Schuurmann; Sara Di Gregorio; Gian Antonio Boschetti; Nabil Chakfé; Bianca Pane; Giovanni Spinella; Jean-Paul de Vries; Domenico Palombo; Giovanni Pratesi

doi:10.1177/1526602821996723

Initial Clinical Experience With a New Conformable Abdominal Aortic Endograft: Aortic Neck Coverage and Curvature Analysis in Challenging Aortic Necks

J Endovasc Ther. 2021 Jun;28(3):407-414. doi: 10.1177/1526602821996723. Epub 2021 Mar 4.

Affiliations

¹ Clinic of Vascular and Endovascular Surgery, Ospedale Policlinico San Martino, Department of Integrated Surgical and Diagnostic Sciences, University of Genoa, Italy.
² Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, the Netherlands.
³ Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, France.
⁴ GEPROVAS, Strasbourg, France.

PMID: 33660576
DOI: 10.1177/1526602821996723

Abstract

Objectives: Aim of this work was to investigate precision of deployment and conformability of a new generation GORE EXCLUDER Conformable Endoprosthesis with active control system (CEXC Device, W.L. Gore and Associates, Flagstaff, AZ, USA) by analyzing aortic neck coverage and curvature.

Methods: All consecutive elective patients affected by abdominal aortic aneurysm or aortoiliac aneurysm treated at our institution between November 2018 and June 2019 with the new CEXC Device were enrolled. Validated software was adopted to determine the available apposition surface area into the aortic neck, apposition of the endograft to the aortic wall, shortest apposition length (SAL), shortest distance between the endograft fabric and the lowest renal arteries (SFD) and between the endograft fabric and the contralateral renal artery (CFD). Pointwise centerline curvature was also computed.

Results: Twelve patients (10 men, median age 78 years (71.75, 81.0)) with available pre- and postoperative computed tomography angiography (CTA) were included. Technical success was obtained in all the cases. Preoperative median length of the proximal aortic neck was 16.1 mm (10.7, 21.7) and suprarenal (α) and infrarenal (β) neck angulation were, respectively, 28.9° (15.7°, 47.5°) and 75.0° (66.9°, 81.4°). Postoperative median apposition surface coverage was 79% (69.25%, 90.75%) of the available apposition surface. SFD and CFD were 1.5 mm (0.75, 5.25) and 7 mm (4.5, 21.5), respectively. Average curvature over the infrarenal aorta decreased from 25 m^-1 (21.75, 29.0) to 22.5 m^-1 (18.75, 24.5) postoperatively (p=0.02). Maximum curvature did not decrease significantly from 64.5 m^-1 (54.25, 92.0) to 62 m^-1 (41.75, 71.5) (p=0.1).

Conclusions: Our early experience showed that deployment of the CEXC Device is safe and effective for patients with challenging proximal aortic necks. Absence of significant changes between pre- and postoperative proximal aortic neck angulations and curvature confirms the high conformability of this endograft.

Keywords: abdominal aortic aneurysm; apposition; endovascular treatment; geometric analysis; sealing.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aorta, Abdominal / diagnostic imaging
Aorta, Abdominal / surgery
Aortic Aneurysm, Abdominal* / diagnostic imaging
Aortic Aneurysm, Abdominal* / surgery
Aortography
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation* / adverse effects
Endovascular Procedures* / adverse effects
Humans
Male
Prosthesis Design
Retrospective Studies
Time Factors
Treatment Outcome