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The Journal of Cardiovascular Surgery 2022 December;63(6):708-15

DOI: 10.23736/S0021-9509.22.12007-0


lingua: Inglese

The influence of narrow aortic bifurcation on limb graft patency: a two-center retrospective study

Wen WEN 1 , Hozan MUFTY 1, Athanasios KATSARGYRIS 2, Geert MALEUX 3, Kim DAENENS 1, Sabrina HOUTHOOFD 1, Inge FOURNEAU 1, Eric VERHOEVEN 2

1 Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium; 2 Department of Vascular and Endovascular Surgery, General Hospital and Paracelsus Medical University, Nuremberg, Germany; 3 Department of Radiology, University Hospitals Leuven, Leuven, Belgium

BACKGROUND: Narrow aortic bifurcation (NAB) has been considered as a potential risk factor for graft limb thrombosis after endovascular aortic repair (EVAR). The aim of this study was to compare mid- and long-term outcome of EVAR in patients with NAB and standard aortic bifurcation (SAB).
METHODS: Data from patients receiving EVAR were prospectively collected and retrospectively analyzed. In case of angiographic limb stenosis (>50%), additional stenting was performed. Patients with a NAB (≤20mm) were included in the NAB group, the remaining patients in the SAB group. Primary endpoints were limb thrombosis rate and technical success.
RESULTS: A total of 902 patients were included; 18.3% (N.=165/902) in the NAB and 81.7% (N.=737/902) in the SAB group. Mean follow-up time was 43 months (range 0-198 months). Bilateral stenting of the aortic bifurcation was performed in 2.7% (N.=27/902), 8.5% (N.=14/165) in the NAB and 1.4% (N.=10/737) in the SAB group (P=0.001). Limb thrombosis was found in 2.8% (N.=25/902), 3.6% (N.=6/165) in the NAB and 2.6% (N.=19/737) in the SAB group (P=0.55). Technical success was 97.8%, 98.8% in the NAB and 97.6% in the SAB group (P=0.33). Device related reintervention rate was 16% (N.=144/902), 15.2% in the NAB and 16.1% in the SAB group (P=0.75).
CONCLUSIONS: Standard EVAR could safely be performed in patients with NAB (≤20mm) when a low threshold for additional stenting was applied. This resulted in no significant higher incidence of limb thrombosis. Additional stent deployment did not increase the complication rate.

KEY WORDS: Aortic aneurysm, abdominal; Endovascular procedures; Graft occlusion, vascular; Vascular patency; Reoperation; Mortality

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