Visceral branch occlusion following aneurysm repair using multibranched thoracoabdominal stent-grafts

J Endovasc Ther. 2014 Dec;21(6):783-90. doi: 10.1583/14-4807R.1.


Purpose: To identify risk factors for late-occurring branch occlusion following multibranched endovascular repair of thoracoabdominal and pararenal aortic aneurysm.

Method: Out of 120 patients who underwent multibranched endovascular aneurysm repair between September 2005 and May 2013, 100 (78 men; mean age 72.4 ± 7.4 years) met the criteria for inclusion in the current retrospective analysis. Demographic data were gleaned from a prospectively maintained database. Mean aneurysm diameter was 66.7 ± 11.7 mm. Multiplanar reconstructions of postoperative computed tomographic angiography were used to measure 6 parameters of renal branch morphology.

Results: All 100 patients had undergone successful placement of multibranched aortic stent-grafts with a total of 95 celiac branches, 100 superior mesenteric artery (SMA) branches, and 187 renal branches. During a mean follow-up of 25.6 months, there were no stent fractures or stent separations, no SMA occlusions, and only 2 (2.1%) celiac artery occlusions, neither of which required reintervention. In contrast, there were 18 (9.6%) renal branch occlusions in 16 patients, all men (p=0.02). Patients with renal branch occlusions were significantly more likely to have a history of myocardial infarction (p=0.004). The mean renal artery length was significantly greater in the occlusion group compared to the non-occlusion group (47.5 ± 13.6 vs. 39.4 ± 14.2, p=0.03). No other aspect of branch morphology was significantly different between the occlusion and non-occlusion groups.

Conclusion: Renal branch occlusion was by far the commonest late failure mode after multibranched endovascular aneurysm repair. The current study provides no basis for a change in patient selection or stent-graft design, only a change in the components used to construct renal branches. It is too early to tell the effect this will have.

Keywords: aneurysm; endovascular repair; multibranched stent-graft; renal artery; stent-graft; thoracoabdominal.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aortic Aneurysm, Abdominal / diagnosis
  • Aortic Aneurysm, Abdominal / surgery*
  • Aortic Aneurysm, Thoracic / diagnosis
  • Aortic Aneurysm, Thoracic / surgery*
  • Aortography / methods
  • Blood Vessel Prosthesis Implantation* / adverse effects
  • Blood Vessel Prosthesis Implantation* / instrumentation
  • Blood Vessel Prosthesis*
  • Endovascular Procedures* / adverse effects
  • Endovascular Procedures* / instrumentation
  • Female
  • Graft Occlusion, Vascular / diagnosis
  • Graft Occlusion, Vascular / etiology*
  • Humans
  • Male
  • Middle Aged
  • Prosthesis Design
  • Retrospective Studies
  • Risk Factors
  • Stents*
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome