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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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The Journal of Cardiovascular Surgery 2015 Jul 16


lingua: Inglese

Abdominal aortic bifurcation anatomy and endograft limbs size affect the use of adjunctive iliac stenting after bifurcated endograft deployment for abdominal aortic aneurysm

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.

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