Multibranched endovascular aortic aneurysm repair in patients with and without chronic aortic dissections

J Vasc Surg. 2019 Nov;70(5):1419-1426. doi: 10.1016/j.jvs.2019.02.048. Epub 2019 Jul 18.

Abstract

Objective: The objective of this study was to compare multibranched endovascular aneurysm repair (MBEVAR) of postdissection thoracoabdominal aortic aneurysms (TAAAs) and pararenal aortic aneurysms (PRAAs) with MBEVAR of degenerative TAAAs and PRAAs and to assess the role played by the preoperative correction of potential complicating factors, such as true lumen compression and false lumen origin of vital branches, using adjunctive maneuvers.

Methods: From July 2005 to July 2017, there were 162 patients who underwent elective MBEVAR of TAAAs and PRAAs. Data on demographics, procedural details, and outcomes were collected prospectively.

Results: The mean age was 73 ± 8 years, and 119 of 162 (74%) were men; 19 of 162 (12%) had prior aortic dissections. Patients with dissections were younger (65 ± 11 years vs 74 ± 7 years; P = .002) and were less likely to have smoked (13/19 [68%] vs 135/143 [94%]; P = .002) or to have peripheral artery disease (0/19 [0%] vs 35/143 [24%]; P = .01) compared with those without dissections. Patients with prior dissections were more likely to have Crawford type II (10/19 [53%] vs 22/143 [15%]; P = .001) and type III (6/19 [32%] vs 16/143 [11%]; P = .03) TAAAs and were more likely to require at least one pre-MBEVAR adjunctive procedure (14/19 [74%] vs 55/143 [38%]; P = .006) compared with those without dissection. There was no difference in perioperative death, stroke, or paraplegia rates between the two groups. Median follow-up was 2.4 years (interquartile range, 0.8-4.7) and did not differ significantly between the two groups. There were no significant differences in branch vessel occlusion, endoleak rate, or aneurysm-related death between the two groups.

Conclusions: Patients with chronic type B aortic dissection are more likely to have extensive aneurysms and more likely to require adjunctive procedures to provide the appropriate anatomic substrate for MBEVAR, but this does not appear to affect the conduct of MBEVAR or its outcomes.

Trial registration: ClinicalTrials.gov NCT00483249.

Keywords: Aortic aneurysm; Branched stent graft; Dissection.

Publication types

  • Clinical Trial
  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aneurysm, Dissecting / etiology
  • Aneurysm, Dissecting / surgery*
  • Aortic Aneurysm, Thoracic / complications
  • Aortic Aneurysm, Thoracic / surgery*
  • Blood Vessel Prosthesis Implantation / adverse effects
  • Blood Vessel Prosthesis Implantation / instrumentation
  • Blood Vessel Prosthesis Implantation / methods*
  • Chronic Disease / therapy
  • Elective Surgical Procedures / adverse effects
  • Elective Surgical Procedures / instrumentation
  • Elective Surgical Procedures / methods*
  • Endovascular Procedures / adverse effects
  • Endovascular Procedures / instrumentation
  • Endovascular Procedures / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Prospective Studies
  • Prosthesis Design
  • Stents / adverse effects
  • Treatment Outcome

Associated data

  • ClinicalTrials.gov/NCT00483249