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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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ORIGINAL ARTICLES  NEW DEVELOPMENTS IN THE MANAGEMENT OF ABDOMINAL AORTIC ANEURYSMS


The Journal of Cardiovascular Surgery 2013 October;54(5):573-80

Copyright © 2013 EDIZIONI MINERVA MEDICA

lingua: Inglese

Early outcome of endovascular aneurysm repair in challenging aortic neck morphology based on experience from the GREAT C3 registry

Bachoo P. 1, Verhoeven E. L. G. 2, Larzon T. 3

1 Department of Vascular Surgery Aberdeen Royal Infirmary, Aberdeen, UK; 2 Department of Vascular and Endovascular Surgery Nuernberg Clinic, Nuernberg, Germany; 3 Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden


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Aim: The aim of this paper was to evaluate early outcome of the GORE® EXCLUDER® AAA Endoprosthesis featuring C3 Delivery System in subjects with aortic neck anatomy outside IFU.
Methods: Individual patient data prospectively collected over a 2 year period from the Global Registry for Endovascular Aortic Treatment (GREAT). For each subject a minimum data set was collected containing demographic, pre/intra- and postoperative variables. Main outcome measures were successful exclusion of the AAA and occurrence of any major endoleak at 1 month. In this study, outside IFU was defined as aortic neck length less than 15 mm and/or aortic neck angle greater than 60 degrees.
Results: A total of 400 subjects, (86.6% male, mean age 73.9 years). Primary pathology was AAA in 94.2% with 98.2% undergoing EVAR as a primary procedure. Sixty-eight subjects underwent EVAR outside IFU (neck length <15 mm N.=32, neck angle >60˙N.=47 and neck length <15 mm and angle >60° N.=11). The graft was successfully deployed within 5 mm of its intended location in 63 (94%) cases utilising a total of 33 repositioning episodes. Eight aortic cuffs were used, 5 to treat a type 1 endoleak. At 30 days we recorded 2 type 2 endoleaks both successfully treated and 1 type 1b also successfully treated. There were 2 deaths, one in each group.
Conclusion: GORE® EXCLUDER® AAA Endoprosthesis featuring C3 Delivery System allows re-positioning to be performed safely in cases outside IFU. Repositioning is an effective operative manoeuvre and facilitates EVAR in challenging anatomy. Longer follow-up is required to evaluate the durability of these results at 30 days.

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paulbachoo@nhs.net