Use of the AFX Stent Graft in Patients with Extremely Narrow Aortic Bifurcation: A Multicenter Retrospective Study

M U Wagenhäuser; N Floros; E Nikitina; J Mulorz; K M Balzer; S Goulas; M Petrich; P Dueppers; F Simon; H Schelzig; A Oberhuber

doi:10.1155/2021/7439173

Use of the AFX Stent Graft in Patients with Extremely Narrow Aortic Bifurcation: A Multicenter Retrospective Study

Int J Vasc Med. 2021 Oct 4:2021:7439173. doi: 10.1155/2021/7439173. eCollection 2021.

Authors

M U Wagenhäuser¹, N Floros¹, E Nikitina², J Mulorz¹, K M Balzer³, S Goulas³, M Petrich⁴, P Dueppers¹, F Simon¹, H Schelzig¹, A Oberhuber⁵

Affiliations

¹ Department of Vascular and Endovascular Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University, Moorenstraße 5, 40225 Duesseldorf, Germany.
² Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University, Moorenstraße 5, 40225 Duesseldorf, Germany.
³ Department of Vascular and Endovascular Surgery, St. Marien-Hospital Bonn, Robert-Koch-Straße 1, 53115 Bonn, Germany.
⁴ Department of Vascular and Endovascular Surgery, Hubertus Protestant Hospital Berlin, Spanische Allee 10-14, 14129 Berlin, Germany.
⁵ Department of Vascular and Endovascular Surgery, University Hospital Muenster, Westphalian Wilhelm University, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany.

Abstract

Introduction: This study analyzed the patient outcomes following endovascular aortic aneurysm repair (EVAR) for infrarenal aortic pathologies with very narrow aortic bifurcations using the AFX stent graft.

Methods: The data was retrieved from the archived medical records of 35 patients treated for abdominal aortic aneurysm (AAA) (48.6%) or penetrating aortic ulcer (PAU) (51.4%) with very narrow aortic bifurcation between January 2013 and May 2020. Patient survival, freedom from endoleak (EL), and limb occlusion were estimated applying the Kaplan-Meier method.

Results: The mean follow-up time was 20.4 ± 22.8 months. The mean aortic bifurcation diameter was 15.8 ± 2.2 mm. Technical success was 100%, and no procedure-related deaths occurred. Two type II ELs occurred within 30-day follow-up. We observed one common iliac artery stenosis at four months and one type III EL at 54 months in the same patient, both of which required re-intervention. Overall patient survival was 95 ± 5% (AAA: 100%; PAU: 89 ± 10%), freedom from limb occlusion was 94 ± 5% (AAA: 91 ± 9%; PAU: 100%), freedom from type II EL was 94 ± 4% (AAA: 88 ± 8%; PAU: 100%), and freedom from EL type III was 83 ± 15% (AAA: 80 ± 18%; PAU: 100%) at the end of the follow-up period.

Conclusions: Very narrow aortic bifurcations may predispose patients to procedure-related complications following EVAR. Our results suggest a safe use of the AFX stent graft in such scenarios. The overall short- and long-term procedure-related patient outcomes are satisfying albeit they may seem superior for PAU when compared to AAA.