Single-Center Experience with the Femoral-to-Brachial Preloaded Delivery System for Fenestrated-Branched Endovascular Repair of Complex Aortic Aneurysms

Guilherme B Barbosa Lima; Aleem K Mirza; Emanuel R Tenorio; Giulianna B Marcondes; Aidin Baghbani-Oskouei; Marina D Neto; Naveed Saqib; Bernardo C Mendes; Thanila A Macedo; Gustavo S Oderich

doi:10.1007/s00270-022-03252-6

Single-Center Experience with the Femoral-to-Brachial Preloaded Delivery System for Fenestrated-Branched Endovascular Repair of Complex Aortic Aneurysms

Cardiovasc Intervent Radiol. 2022 Oct;45(10):1451-1461. doi: 10.1007/s00270-022-03252-6. Epub 2022 Sep 1.

Affiliations

¹ McGovern Medical School, The University of Texas Health Science Center at Houston, 6400 Fannin Street Suite 2850, Houston, TX, 77030, USA.
² Mayo Clinic, Rochester, MN, USA.
³ McGovern Medical School, The University of Texas Health Science Center at Houston, 6400 Fannin Street Suite 2850, Houston, TX, 77030, USA. gustavo.oderich@uth.tmc.edu.

PMID: 36050563
DOI: 10.1007/s00270-022-03252-6

Abstract

Purpose: To assess technical aspects and outcomes of fenestrated-branched endovascular aortic repair (FB-EVAR) using a femoral-to-brachial (FTB) preloaded delivery system (PDS) with two separate configurations.

Methods: Clinical data of all consecutive patients enrolled in a prospective study to evaluate FB-EVAR for complex abdominal and thoracoabdominal aortic aneurysms (CAAAs & TAAA) between 2013 and 2020 were reviewed. Patients treated with FTB-PDS were included. The two configurations included 4 trans-brachial preloaded wires (4BR) or 2 trans-brachial and 2 transfemoral preloaded wires (2BR-2FE). Outcome measures included technical success, procedural metrics, 30-day or in-hospital mortality, major adverse events (MAEs), and target-vessel outcomes.

Results: There were 115 patients with a mean age of 73.8 ± 8 years, treated with FTB-PDS. Of these, 62 patients (54%) had 4BR and 53 patients (46%) had 2BR-2FE FTB-PDS. There were 106 TAAA (92%) and 9 CAAAs (8%). Technical success, defined as successful implantation of the stent-graft and all intended target-vessel stents without type I or III endoleak, was 97%, with no differences in total operating time, endovascular time, and radiation dose between groups. There were 3 deaths (3%) at 30 days. MAEs were noticed in 21 patients (18%) with no difference between groups, including new-onset dialysis (2% vs. 4%, P = 0.59), and paraplegia (7% vs. 11%, P = 0.51), for 4BR and 2BR-2FE, respectively. Patient survival and freedom from aortic-related mortality at 2-years were 79 ± 5% and 97 ± 1.7%, respectively, with no difference between groups.

Conclusion: The use of FTB-PDS for FB-EVAR is safe with high technical success and a reasonable rate of MAEs. Each configuration provides specific benefits based on patient anatomy, while having similar procedural metrics and clinical outcomes.

Keywords: Fenestrated-branched endovascular aortic repair; Thoracoabdominal aortic aneurysm; Upper extremity preloaded delivery system.

MeSH terms

Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal* / surgery
Aortic Aneurysm, Thoracic* / diagnostic imaging
Aortic Aneurysm, Thoracic* / etiology
Aortic Aneurysm, Thoracic* / surgery
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation* / adverse effects
Endovascular Procedures* / adverse effects
Humans
Prospective Studies
Prosthesis Design
Stents
Treatment Outcome