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International Angiology 2022 Jan 10

DOI: 10.23736/S0392-9590.22.04745-9


language: English

Early experience with the Bolton Relay Pro/Plus for physician-modified fenestrated TEVAR

Giuseppe ASCIUTTO 1, 2, Marco V. USAI 3, Abdulhakim IBRAHIM 1 , Alexander OBERHUBER 1

1 Department of Vascular and Endovascular Surgery, University Hospital Münster, Münster, Germany; 2 Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; 3 Department of Vascular and Endovascular Surgery, St. Franziskus Hospital Münster, Münster, Germany

BACKGROUND: Thoracic endovascular aortic repair (TEVAR) can be challenging in cases involving the aortic arch and the visceral segment. We report our initial experience with fenestrated TEVAR (f-TEVAR) for thoracic aortic disease involving aortic branches using physician-modified stent grafts (PMSGs).
MATERIALS AND METHODS: Between February 2019 and November 2020 nine patients were treated with a PMSG. Indication to treatment were a symptomatic acute type B aortic dissection (TBAD) in three cases, a penetrating aortic ulcer in three cases (two in zone 3 and one in zone 6), one case of an endoleak type I A after TEVAR, a chronic TBAD after TEVAR in one case and one case of a contained rupture of a thoracoabdominal aneurysm in zone 3. Pre-, intra- and postoperative clinical data were recorded.
RESULTS: The median patient age was 65 (IQR 60.5-71) years, and 8 (89%) patients were men. Nine stent grafts (six Bolton Relay Plus and three Bolton Relay Pro, Terumo Aortic, Vascutek Ltd., Inchinnan, United Kingdom) were deployed. Small fenestrations (8 mm) were created on table, median duration for on table stent graft modifications was 20 minutes (13-22). The technical success rate was 100%. Median operative time was 188 (116-252) minutes. No major adverse events of any sort occurred during the first 30-day postoperatively. There were no type I or type III endoleaks at the end of the procedure, and no cases of spinal cord ischemia. Two access related complications occurred (22%). After a median of 12 (range 5-12) months all patients survived and all target vessels remained patent with one case of fenestration-related type I endoleak, which required open conversion.
CONCLUSIONS: The results of our initial experience with f-TEVAR using PMSGs with the Bolton Relay stentgraft for the treatment of aortic diseases are acceptable. These results should be confirmed on larger patient cohorts.

KEY WORDS: Physician-modified stent grafts; Thoracic endovascular aortic repair; Aortic dissection

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