Early Limb Reperfusion Using Routinely Preloaded Fenestrated Stent-graft Designs for Complex Endovascular Aortic Procedures

Luca Bertoglio, Diletta Loschi, Alessandro Grandi, Andrea Melloni, Victor Bilman, Germano Melissano, Roberto Chiesa

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: To evaluate the outcomes of the preloaded stent-graft design (PLD) in the routine treatment of pararenal and thoraco-abdominal aneurysms compared to the standard design (SND). Methods: Patients treated by fenestrated/branched endovascular aneurysm repair from 2013 were collected. Since 2017, PLD (23F delivery system) was implemented in our standard practice and the outcomes are reported. Primary outcome measurements were: technical success, 30-day adverse events, leg ischemia time, procedural time and radiation exposure. Secondary outcome measurements were: intraoperative urinary output, need of bicarbonate supplementation, postoperative biomarkers elevations and need for blood transfusions. A propensity 1:1 matching for graft design and aneurysm extent was performed with the SND (18F delivery system) cohort to highlight possible PLD advantages. Results: A PLD was employed in 32 non-consecutive patients with a technical and clinical success rate of 100% and 81% respectively: no mortality was recorded. The Society for Vascular Surgery grade ≥ 1 adverse event was observed in 10 cases (31%): five temporary paraparesis were observed. Seventeen PLD patients were matched. The procedural time was shorter in PLD group (266 vs. 390 min; p = 0.001) as well as fluoroscopy time (68 vs. 96 min; p = 0.019) and contrast media used (180 vs. 382 ml; p = 0.045). Contralateral limb ischemic time was significantly higher in SND group (0 vs. 70 min; p = 0.042). The need for blood transfusion and the postoperative peak of creatine phosphokinase was lower in PLD group (151 vs. 449 U/l; p < 0.001). Conclusions: Preloaded stent-graft design allows a uni-femoral approach in the majority of the interventions reducing procedural times and the ischemia on the contralateral leg, leading to possible benefits.

Original languageEnglish
Pages (from-to)1868-1880
Number of pages13
JournalCardioVascular and Interventional Radiology
Volume43
Issue number12
DOIs
Publication statusPublished - Dec 1 2020

Keywords

  • Branched
  • Endovascular
  • Fenestrated
  • Ischemia
  • Limb
  • Paraplegia
  • Spinal cord
  • Thoraco-abdominal aneurysms

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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