Cardiovascular and interventional radiology · 2020
Early Limb Reperfusion Using Routinely Preloaded Fenestrated Stent-graft Designs for Complex Endovascular Aortic Procedures.
СтатьяНазвание и аннотация: Перевод в очереди
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Bertoglio Luca, Loschi Diletta, Grandi Alessandro, Melloni Andrea, Bilman Victor, Melissano Germano, Chiesa Roberto
Аннотация
INTRODUCTION: To evaluate the outcomes of the preloaded stent-graft design (PLD) in the routine treatment of pararenal and thoraco-abdominal aneurysms compared to the standard design (SND).
METHODS: Patients treated by fenestrated/branched endovascular aneurysm repair from 2013 were collected. Since 2017, PLD (23F delivery system) was implemented in our standard practice and the outcomes are reported. Primary outcome measurements were: technical success, 30-day adverse events, leg ischemia time, procedural time and radiation exposure. Secondary outcome measurements were: intraoperative urinary output, need of bicarbonate supplementation, postoperative biomarkers elevations and need for blood transfusions. A propensity 1:1 matching for graft design and aneurysm extent was performed with the SND (18F delivery system) cohort to highlight possible PLD advantages.
RESULTS: A PLD was employed in 32 non-consecutive patients with a technical and clinical success rate of 100% and 81% respectively: no mortality was recorded. The Society for Vascular Surgery grade ≥ 1 adverse event was observed in 10 cases (31%): five temporary paraparesis were observed. Seventeen PLD patients were matched. The procedural time was shorter in PLD group (266 vs. 390 min; p = 0.001) as well as fluoroscopy time (68 vs. 96 min; p = 0.019) and contrast media used (180 vs. 382 ml; p = 0.045). Contralateral limb ischemic time was significantly higher in SND group (0 vs. 70 min; p = 0.042). The need for blood transfusion and the postoperative peak of creatine phosphokinase was lower in PLD group (151 vs. 449 U/l; p < 0.001).
CONCLUSIONS: Preloaded stent-graft design allows a uni-femoral approach in the majority of the interventions reducing procedural times and the ischemia on the contralateral leg, leading to possible benefits.
METHODS: Patients treated by fenestrated/branched endovascular aneurysm repair from 2013 were collected. Since 2017, PLD (23F delivery system) was implemented in our standard practice and the outcomes are reported. Primary outcome measurements were: technical success, 30-day adverse events, leg ischemia time, procedural time and radiation exposure. Secondary outcome measurements were: intraoperative urinary output, need of bicarbonate supplementation, postoperative biomarkers elevations and need for blood transfusions. A propensity 1:1 matching for graft design and aneurysm extent was performed with the SND (18F delivery system) cohort to highlight possible PLD advantages.
RESULTS: A PLD was employed in 32 non-consecutive patients with a technical and clinical success rate of 100% and 81% respectively: no mortality was recorded. The Society for Vascular Surgery grade ≥ 1 adverse event was observed in 10 cases (31%): five temporary paraparesis were observed. Seventeen PLD patients were matched. The procedural time was shorter in PLD group (266 vs. 390 min; p = 0.001) as well as fluoroscopy time (68 vs. 96 min; p = 0.019) and contrast media used (180 vs. 382 ml; p = 0.045). Contralateral limb ischemic time was significantly higher in SND group (0 vs. 70 min; p = 0.042). The need for blood transfusion and the postoperative peak of creatine phosphokinase was lower in PLD group (151 vs. 449 U/l; p < 0.001).
CONCLUSIONS: Preloaded stent-graft design allows a uni-femoral approach in the majority of the interventions reducing procedural times and the ischemia on the contralateral leg, leading to possible benefits.