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International Angiology 2021 Oct 12

DOI: 10.23736/S0392-9590.21.04718-0


lingua: Inglese

Distal landing zone outcomes in thoracic endovascular aortic aneurysm repair with challenging morphology: a propensity-matched comparison of distal active fixation versus standard stent-graft

Stefano GENNAI 1, Nicola LEONE 1 , Angelos KARELIS 2, Andrea XODO 3, Luca MEZZETTO 4, Aaron FARGION 5, Michele ANTONELLO 3, Gian Franco VERALDI 4, Nuno V. DIAS 2, Björn SONESSON 2, Carlo PRATESI 5, Roberto SILINGARDI 1

1 Department of Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy; 2 Vascular Center, Department of Thoracic Surgery and Vascular Diseases, Vascular Center, Skåne University Hospital, Malmö, Sweden; 3 Vascular and Endovascular Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy; 4 Vascular Surgery, University Hospital of Verona, Verona, Italy; 5 Department of Vascular Surgery, University of Florence, Florence, Italy


BACKGROUND: To evaluate the distal landing zone (LZ) outcomes in adverse morphology after thoracic endovascular repair (TEVAR) with distal active fixation (DAF) stent-grafts compared with standard endografts.
METHODS: between 2006 and the 31st December 2020, sixty-nine DAFs (study group) and sixty-nine standard stent-grafts (control group) were enrolled in a multi-center, retrospective, case-control study. The primary outcomes were the distal endoleak and reintervention. The secondary outcomes were: distal segment migration, wedge apposition and related complications. A univariate and multivariate logistic regression followed by a propensity-scored model (1:1) were performed.
RESULTS: The results were reported for the DAF vs control group. The mean follow-up was 3.3 ± 2.1 vs 3.7 ± 3.4 years. The distal endoleak rate was 7.3% vs 27.5% (P=0.011). The freedom from distal endoleak was 95%, 95% and 91% vs 85%, 76%, and 73% at 1, 3 and 5 years respectively (Log-rank P=0.011). Tortuosity index and distal thoracic aorta angulation were predictors of endoleak (P=0.012 and P=0.029 respectively). The distal reinterventions rate was 7.3% vs 20.3% (P=0.026). The freedom from distal reinterventions was 95%, 95% and 91% vs 92%, 75% and 75% at 1, 3 and 5 years respectively (Log-rank P=0.041). The wedge apposition was 5.8 vs 13.0-mm (P<0.000). The distal segment migration was upward directed in all cases and was significant (>10- mm) in 13.0% vs 39.1% (P=0.000).
CONCLUSIONS: The DAF stent-graft showed a significant reduction of the distal endoleak rates and other specific outcomes of the distal LZ in patients with an adverse anatomy.

KEY WORDS: Aneurysm; Endovascular technique; Thoracic aorta; Endoleak

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