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Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632
Online ISSN 1827-191X
Bianchini Massoni C. 1, Gargiulo M. 1, Freyrie A. 1, Gallitto E. 1, De Matteis M. 2, Mascoli C. 1, Stella A. 1
1 Vascular Surgery, Department of Experimental, Diagnostic and Speciality Medicine, University of Bologna, Policlinico Sant’Orsola–Malpighi, Bologna, Italy;
2 Radiology, Azienda Policlinico S. Orsola-Malpighi, Bologna, Italy
OBJECTIVES: The aims of the study are(1)to define the incidence of intraoperative endograft limb stenosis >50%(ELS) after bifurcated EVAR,(2)to find risk factors for ELS considering morphology of aortic bifurcation and structural characteristics of endograft iliac limbs,(3)to evaluate early and follow-up outcomes of intraoperative adjunctive endograft iliac stenting.
METHODS: Patients treated with bifurcated EVAR for abdominal aortic aneurysm were prospectively collected from 2005 to 2011.Patient demographics, clinical risk factors, preoperative aortic bifurcation morphology(minimum and maximum diameter[ABD], calcification[ABC]), endograft iliac limb parameters(diameters[ELDs],stent material, type of endograft), ratio between diameters of endograft limbs and maximum diameter of aortic bifurcation(ELDs/ABD), perioperative endograft limb stenosis(ELS) and results during follow-up were analyzed.Primary outcomes were incidence of perioperative ELS and risk factors for its occurrence.Considering adjunctive stenting procedure, secondary outcomes were technical success, 30-day and mid-term iliac endograft leg patency and clinical success.
RESULTS: Two hundred forty-seven patients(men 233; mean age 74±7years) were included.Mean maximum ABD was 28.9±12.9 mm. ABC was ≥50% in 56(22.7%) cases.Median sum of endograft limbs diameters(ELDs) was 31 mm(IQR 13-46). Endograft limb with stainless steel and nitinol stents was deployed in 69(27.9%) and 178(72.1%) patients. Median ELDs/ABD was 1.2(IQR 0.9-1.5). ELS in aortic bifurcation occurred in 42(8.5%) endograft limbs in 36(14.6%) patients. ABD≤20 mm, ABC≥50%, ELDs≥30mm, nitinol endograft stents and ELDs/ABD>1.4 were identified as possible positive predictive factors. At univariate and multivariate analysis, ELDs/ABD>1.4 resulted a positive prognostic factor for ELS(.008 and .022, respectively). Forty-two adjunctive stents were deployed in 36(14.6%) patients as intraoperative adjunctive procedure. Technical success, 30-day iliac endograft leg patency was 100%. Mean follow-up was 33 months(range 6-55 months) and mid-term clinical success and iliac endograft limb patency were 100%.
CONCLUSIONS: ELS is a common event after EVAR with bifurcated endograft and ELDs/ABD>1.4 results positive predictive factor. Adjunctive stenting is a safe and effective procedure and ensures optimal mid-term endograft limb patency.