Exclusion of Healthy Aorta in Complex Aneurysmatic Aortic Pathologies in Endovascular Repair.

BACKGROUND: Endovascular repair (ER) requires to seal within a healthy aorta, resulting in longer exclusion in comparison to open repair. This study aimed to quantify the length and the number of occluded segmental arteries after every ER compared to a hypothetical open repair (HOR) and, secondary, to assess the anatomical factors related to spinal cord ischemia (SCI) in juxtarenal (JAAAs) and pararenal aneurysms (PAAAs).

METHODS: Patients treated by ER between 2014 and 2023 in our center were included. Using OsiriX®, we reviewed every preoperative and postoperative CTA scans, generating center lumen lines for measurements.

RESULTS: Seventy-seven patients were included (37 JAAA, 6 PAAA and 34 TAA) undergoing 39 fenestrated endovascular aortic repair (FEVAR), 31 branched endovascular aortic repair, and 7 branched/FEVAR. Median length of aortic exclusion in ER is 276.41 ± 112.31 mm compared to HOR 182.07 ± 87.18 mm (P < 0.001, with significance maintained in JAAA, PAAA, and type III TAAA. The number of occluded segmental arteries after ER was significant in the juxtarenal (P < 0.001) and type III TAA compared to HOR. Four cases of transient SCI in the JAAA and PAAA, with significant association identified for aortic exclusion >250 mm and with the chronic or intended internal iliac arteries occlusion.

CONCLUSION: ER results in significantly longer aortic exclusion and more occluded segmental arteries than HOR, particularly in JAAA and PAAA. It is necessary to perform a comparative study with open repair to better evaluate the potential increased risk of SCI in these subgroups.