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Mid-term Renal and Mesenteric Artery Outcomes During Fenestrated and Branched Endovascular Aortic Repair for Complex Abdominal and Thoracoabdominal Aortic Aneurysms in the United States Aortic Research Consortium.
Tenorio, Emanuel R; Schanzer, Andres; Timaran, Carlos H; Schneider, Darren B; Mendes, Bernardo C; Eagleton, Matthew J; Farber, Mark A; Parodi, Federico Ezequiel; Gasper, Warren J; Beck, Adam W; Sweet, Matthew P; Huang, Ying; Oderich, Gustavo S.
Afiliación
  • Tenorio ER; Department of Cardiothoracic and Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX.
  • Schanzer A; Division of Vascular and Endovascular Surgery, University of Massachusetts Medical School, Worcester, MA.
  • Timaran CH; Division of Vascular and Endovascular Surgery, University of Texas Southwestern, Dallas, TX.
  • Schneider DB; Division of Vascular and Endovascular Surgery, University of Pennsylvania, Philadelphia, PA.
  • Mendes BC; Division of Vascular and Endovascular, Mayo Clinic, Rochester, MN.
  • Eagleton MJ; Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA.
  • Farber MA; Division of Vascular Surgery, University of North Carolina, Chapel Hill, NC.
  • Parodi FE; Division of Vascular Surgery, University of North Carolina, Chapel Hill, NC.
  • Gasper WJ; Division of Vascular and Endovascular Surgery, University of California San Francisco, San Francisco, CA.
  • Beck AW; Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL.
  • Sweet MP; Division of Vascular Surgery, University of Washington, Seattle, WA.
  • Huang Y; Department of Cardiothoracic and Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX.
  • Oderich GS; Department of Cardiothoracic and Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX.
Ann Surg ; 278(4): e893-e902, 2023 10 01.
Article en En | MEDLINE | ID: mdl-37051912
OBJECTIVE: To report mid-term outcomes of renal-mesenteric target arteries (TAs) after fenestrated-branched endovascular aortic repair (FB-EVAR) of complex abdominal and thoracoabdominal aortic aneurysm. BACKGROUND: TA instability (TAI) is the most frequent indication for reintervention after FB-EVAR. METHODS: Data from consecutive patients enrolled in 9 prospective nonrandomized physician-sponsored investigational device exemption studies between 2005 and 2020 were reviewed. TA outcomes through 5 years of follow-up were analyzed for vessels incorporated by fenestrations or directional branches (DBs), including TA patency, endoleak, integrity failure, reintervention, and instability. RESULTS: A total of 1681 patients had 6349 renal-mesenteric arteries were targeted using 3720 fenestrations (59%), 2435 DBs (38%), and 194 scallops (3%). Mean follow was 23 ± 21 months. At 5 years, TAs incorporated by fenestrations had higher primary (95 ± 1% vs 91 ± 1%, P < 0.001) and secondary patency (98 ± 1% vs 94 ± 1%, P < 0.001), and higher freedom from TAI (87 ± 2% vs 84 ± 2%, P = 0.002) compared with TAs incorporated by DBs, with no differences in other TA events. DBs targeted by balloon-expandable stent-grafts had significantly lower freedom from TAI (78 ± 4% vs 88 ± 1%, P = 0.006), TA endoleak (87 ± 3% vs 97 ± 1%, P < 0.001), and TA reintervention (83 ± 4% vs 95 ± 1%, P < 0.001) compared with those targeted by self-expandable stent-grafts. CONCLUSIONS: Incorporation of renal and mesenteric TA during FB-EVAR is safe and durable with high 5-year patency rates and low freedom from TAI. DBs have lower patency rates and lower freedom from TAI than fenestrations, with better performance for self-expandable stent grafts as compared with balloon-expandable stent grafts.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Aneurisma de la Aorta Torácica / Aneurisma de la Aorta Abdominal / Implantación de Prótesis Vascular / Procedimientos Endovasculares / Aneurisma de la Aorta Toracoabdominal Tipo de estudio: Clinical_trials / Etiology_studies / Observational_studies / Risk_factors_studies Límite: Humans País/Región como asunto: America do norte Idioma: En Revista: Ann Surg Año: 2023 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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PubMed Links
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Aneurisma de la Aorta Torácica / Aneurisma de la Aorta Abdominal / Implantación de Prótesis Vascular / Procedimientos Endovasculares / Aneurisma de la Aorta Toracoabdominal Tipo de estudio: Clinical_trials / Etiology_studies / Observational_studies / Risk_factors_studies Límite: Humans País/Región como asunto: America do norte Idioma: En Revista: Ann Surg Año: 2023 Tipo del documento: Article Pais de publicación: Estados Unidos