Configuration affects parallel stent grafting results
A number of adjunctive “off-the-shelf” procedures have been described to treat complex aortic diseases. Our goal was to evaluate parallel stent graft configurations and to determine an optimal formula for these procedures. This is a retrospective review of all patients at a single medical center tre...
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| Veröffentlicht in: | Journal of vascular surgery 2018-05, Vol.67 (5), p.1353-1359 |
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| creator | Tanious, Adam Wooster, Mathew Armstrong, Paul A. Zwiebel, Bruce Grundy, Shane Back, Martin R. Shames, Murray L. |
| description | A number of adjunctive “off-the-shelf” procedures have been described to treat complex aortic diseases. Our goal was to evaluate parallel stent graft configurations and to determine an optimal formula for these procedures.
This is a retrospective review of all patients at a single medical center treated with parallel stent grafts from January 2010 to September 2015. Outcomes were evaluated on the basis of parallel graft orientation, type, and main body device. Primary end points included parallel stent graft compromise and overall endovascular aneurysm repair (EVAR) compromise.
There were 78 patients treated with a total of 144 parallel stents for a variety of pathologic processes. There was a significant correlation between main body oversizing and snorkel compromise (P = .0195) and overall procedural complication (P = .0019) but not with endoleak rates. Patients were organized into the following oversizing groups for further analysis: 0% to 10%, 10% to 20%, and >20%. Those oversized into the 0% to 10% group had the highest rate of overall EVAR complication (73%; P = .0003). There were no significant correlations between any one particular configuration and overall procedural complication. There was also no significant correlation between total number of parallel stents employed and overall complication. Composite EVAR configuration had no significant correlation with individual snorkel compromise, endoleak, or overall EVAR or procedural complication. The configuration most prone to individual snorkel compromise and overall EVAR complication was a four-stent configuration with two stents in an antegrade position and two stents in a retrograde position (60% complication rate). The configuration most prone to endoleak was one or two stents in retrograde position (33% endoleak rate), followed by three stents in an all-antegrade position (25%). There was a significant correlation between individual stent configuration and stent compromise (P = .0385), with 31.25% of retrograde stents having any complication.
Parallel stent grafting offers an off-the-shelf option to treat a variety of aortic diseases. There is an increased risk of parallel stent and overall EVAR compromise with 20%. |
| doi_str_mv | 10.1016/j.jvs.2017.09.025 |
| format | Article |
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This is a retrospective review of all patients at a single medical center treated with parallel stent grafts from January 2010 to September 2015. Outcomes were evaluated on the basis of parallel graft orientation, type, and main body device. Primary end points included parallel stent graft compromise and overall endovascular aneurysm repair (EVAR) compromise.
There were 78 patients treated with a total of 144 parallel stents for a variety of pathologic processes. There was a significant correlation between main body oversizing and snorkel compromise (P = .0195) and overall procedural complication (P = .0019) but not with endoleak rates. Patients were organized into the following oversizing groups for further analysis: 0% to 10%, 10% to 20%, and >20%. Those oversized into the 0% to 10% group had the highest rate of overall EVAR complication (73%; P = .0003). There were no significant correlations between any one particular configuration and overall procedural complication. There was also no significant correlation between total number of parallel stents employed and overall complication. Composite EVAR configuration had no significant correlation with individual snorkel compromise, endoleak, or overall EVAR or procedural complication. The configuration most prone to individual snorkel compromise and overall EVAR complication was a four-stent configuration with two stents in an antegrade position and two stents in a retrograde position (60% complication rate). The configuration most prone to endoleak was one or two stents in retrograde position (33% endoleak rate), followed by three stents in an all-antegrade position (25%). There was a significant correlation between individual stent configuration and stent compromise (P = .0385), with 31.25% of retrograde stents having any complication.
Parallel stent grafting offers an off-the-shelf option to treat a variety of aortic diseases. There is an increased risk of parallel stent and overall EVAR compromise with <10% main body oversizing. Thirty-day mortality is increased when more than one parallel stent is placed. Antegrade configurations are preferred to any retrograde configuration, with optimal oversizing >20%.</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/j.jvs.2017.09.025</identifier><identifier>PMID: 29153534</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aortic Aneurysm - diagnostic imaging ; Aortic Aneurysm - surgery ; Aortography - methods ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation - adverse effects ; Blood Vessel Prosthesis Implantation - instrumentation ; Blood Vessel Prosthesis Implantation - mortality ; Computed Tomography Angiography ; Endoleak - etiology ; Endovascular Procedures - adverse effects ; Endovascular Procedures - instrumentation ; Endovascular Procedures - mortality ; Female ; Florida ; Humans ; Kaplan-Meier Estimate ; Logistic Models ; Male ; Multivariate Analysis ; Odds Ratio ; Prosthesis Design ; Retrospective Studies ; Risk Factors ; Stents ; Time Factors ; Treatment Outcome</subject><ispartof>Journal of vascular surgery, 2018-05, Vol.67 (5), p.1353-1359</ispartof><rights>2017 Society for Vascular Surgery</rights><rights>Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c396t-26c703319edd194841b82b2487fcf9bdf899422b97113d1a035a8e81ee7a552f3</citedby><cites>FETCH-LOGICAL-c396t-26c703319edd194841b82b2487fcf9bdf899422b97113d1a035a8e81ee7a552f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jvs.2017.09.025$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3548,27923,27924,45994</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29153534$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tanious, Adam</creatorcontrib><creatorcontrib>Wooster, Mathew</creatorcontrib><creatorcontrib>Armstrong, Paul A.</creatorcontrib><creatorcontrib>Zwiebel, Bruce</creatorcontrib><creatorcontrib>Grundy, Shane</creatorcontrib><creatorcontrib>Back, Martin R.</creatorcontrib><creatorcontrib>Shames, Murray L.</creatorcontrib><title>Configuration affects parallel stent grafting results</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>A number of adjunctive “off-the-shelf” procedures have been described to treat complex aortic diseases. Our goal was to evaluate parallel stent graft configurations and to determine an optimal formula for these procedures.
This is a retrospective review of all patients at a single medical center treated with parallel stent grafts from January 2010 to September 2015. Outcomes were evaluated on the basis of parallel graft orientation, type, and main body device. Primary end points included parallel stent graft compromise and overall endovascular aneurysm repair (EVAR) compromise.
There were 78 patients treated with a total of 144 parallel stents for a variety of pathologic processes. There was a significant correlation between main body oversizing and snorkel compromise (P = .0195) and overall procedural complication (P = .0019) but not with endoleak rates. Patients were organized into the following oversizing groups for further analysis: 0% to 10%, 10% to 20%, and >20%. Those oversized into the 0% to 10% group had the highest rate of overall EVAR complication (73%; P = .0003). There were no significant correlations between any one particular configuration and overall procedural complication. There was also no significant correlation between total number of parallel stents employed and overall complication. Composite EVAR configuration had no significant correlation with individual snorkel compromise, endoleak, or overall EVAR or procedural complication. The configuration most prone to individual snorkel compromise and overall EVAR complication was a four-stent configuration with two stents in an antegrade position and two stents in a retrograde position (60% complication rate). The configuration most prone to endoleak was one or two stents in retrograde position (33% endoleak rate), followed by three stents in an all-antegrade position (25%). There was a significant correlation between individual stent configuration and stent compromise (P = .0385), with 31.25% of retrograde stents having any complication.
Parallel stent grafting offers an off-the-shelf option to treat a variety of aortic diseases. There is an increased risk of parallel stent and overall EVAR compromise with <10% main body oversizing. Thirty-day mortality is increased when more than one parallel stent is placed. Antegrade configurations are preferred to any retrograde configuration, with optimal oversizing >20%.</description><subject>Aged</subject><subject>Aortic Aneurysm - diagnostic imaging</subject><subject>Aortic Aneurysm - surgery</subject><subject>Aortography - methods</subject><subject>Blood Vessel Prosthesis</subject><subject>Blood Vessel Prosthesis Implantation - adverse effects</subject><subject>Blood Vessel Prosthesis Implantation - instrumentation</subject><subject>Blood Vessel Prosthesis Implantation - mortality</subject><subject>Computed Tomography Angiography</subject><subject>Endoleak - etiology</subject><subject>Endovascular Procedures - adverse effects</subject><subject>Endovascular Procedures - instrumentation</subject><subject>Endovascular Procedures - mortality</subject><subject>Female</subject><subject>Florida</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Multivariate Analysis</subject><subject>Odds Ratio</subject><subject>Prosthesis Design</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Stents</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kDtPwzAURi0EoqXwA1hQRpYEXz_iWEyo4iVVYoHZcpzrylWaFDtB4t-TqoWR6S7nO9I9hFwDLYBCebcpNl-pYBRUQXVBmTwhc6Ba5WVF9SmZUyUglwzEjFyktKEUQFbqnMyYBsklF3Mil33nw3qMdgh9l1nv0Q0p29lo2xbbLA3YDdk6Wj-Ebp1FTGM7pEty5m2b8Op4F-Tj6fF9-ZKv3p5flw-r3HFdDjkrnaKcg8amAS0qAXXFaiYq5Z3XdeMrrQVjtVYAvAFLubQVVoCorJTM8wW5PXh3sf8cMQ1mG5LDtrUd9mMyoMtSCKkUm1A4oC72KUX0ZhfD1sZvA9Tsa5mNmWqZfS1DtZlqTZubo36st9j8LX7zTMD9AcDpya-A0SQXsHPYhDh1Mk0f_tH_AJyseeQ</recordid><startdate>201805</startdate><enddate>201805</enddate><creator>Tanious, Adam</creator><creator>Wooster, Mathew</creator><creator>Armstrong, Paul A.</creator><creator>Zwiebel, Bruce</creator><creator>Grundy, Shane</creator><creator>Back, Martin R.</creator><creator>Shames, Murray L.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201805</creationdate><title>Configuration affects parallel stent grafting results</title><author>Tanious, Adam ; Wooster, Mathew ; Armstrong, Paul A. ; Zwiebel, Bruce ; Grundy, Shane ; Back, Martin R. ; Shames, Murray L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c396t-26c703319edd194841b82b2487fcf9bdf899422b97113d1a035a8e81ee7a552f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Aged</topic><topic>Aortic Aneurysm - diagnostic imaging</topic><topic>Aortic Aneurysm - surgery</topic><topic>Aortography - methods</topic><topic>Blood Vessel Prosthesis</topic><topic>Blood Vessel Prosthesis Implantation - adverse effects</topic><topic>Blood Vessel Prosthesis Implantation - instrumentation</topic><topic>Blood Vessel Prosthesis Implantation - mortality</topic><topic>Computed Tomography Angiography</topic><topic>Endoleak - etiology</topic><topic>Endovascular Procedures - adverse effects</topic><topic>Endovascular Procedures - instrumentation</topic><topic>Endovascular Procedures - mortality</topic><topic>Female</topic><topic>Florida</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Multivariate Analysis</topic><topic>Odds Ratio</topic><topic>Prosthesis Design</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Stents</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tanious, Adam</creatorcontrib><creatorcontrib>Wooster, Mathew</creatorcontrib><creatorcontrib>Armstrong, Paul A.</creatorcontrib><creatorcontrib>Zwiebel, Bruce</creatorcontrib><creatorcontrib>Grundy, Shane</creatorcontrib><creatorcontrib>Back, Martin R.</creatorcontrib><creatorcontrib>Shames, Murray L.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tanious, Adam</au><au>Wooster, Mathew</au><au>Armstrong, Paul A.</au><au>Zwiebel, Bruce</au><au>Grundy, Shane</au><au>Back, Martin R.</au><au>Shames, Murray L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Configuration affects parallel stent grafting results</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2018-05</date><risdate>2018</risdate><volume>67</volume><issue>5</issue><spage>1353</spage><epage>1359</epage><pages>1353-1359</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><abstract>A number of adjunctive “off-the-shelf” procedures have been described to treat complex aortic diseases. Our goal was to evaluate parallel stent graft configurations and to determine an optimal formula for these procedures.
This is a retrospective review of all patients at a single medical center treated with parallel stent grafts from January 2010 to September 2015. Outcomes were evaluated on the basis of parallel graft orientation, type, and main body device. Primary end points included parallel stent graft compromise and overall endovascular aneurysm repair (EVAR) compromise.
There were 78 patients treated with a total of 144 parallel stents for a variety of pathologic processes. There was a significant correlation between main body oversizing and snorkel compromise (P = .0195) and overall procedural complication (P = .0019) but not with endoleak rates. Patients were organized into the following oversizing groups for further analysis: 0% to 10%, 10% to 20%, and >20%. Those oversized into the 0% to 10% group had the highest rate of overall EVAR complication (73%; P = .0003). There were no significant correlations between any one particular configuration and overall procedural complication. There was also no significant correlation between total number of parallel stents employed and overall complication. Composite EVAR configuration had no significant correlation with individual snorkel compromise, endoleak, or overall EVAR or procedural complication. The configuration most prone to individual snorkel compromise and overall EVAR complication was a four-stent configuration with two stents in an antegrade position and two stents in a retrograde position (60% complication rate). The configuration most prone to endoleak was one or two stents in retrograde position (33% endoleak rate), followed by three stents in an all-antegrade position (25%). There was a significant correlation between individual stent configuration and stent compromise (P = .0385), with 31.25% of retrograde stents having any complication.
Parallel stent grafting offers an off-the-shelf option to treat a variety of aortic diseases. There is an increased risk of parallel stent and overall EVAR compromise with <10% main body oversizing. Thirty-day mortality is increased when more than one parallel stent is placed. Antegrade configurations are preferred to any retrograde configuration, with optimal oversizing >20%.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>29153534</pmid><doi>10.1016/j.jvs.2017.09.025</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; ScienceDirect Journals (5 years ago - present) |
| subjects | Aged Aortic Aneurysm - diagnostic imaging Aortic Aneurysm - surgery Aortography - methods Blood Vessel Prosthesis Blood Vessel Prosthesis Implantation - adverse effects Blood Vessel Prosthesis Implantation - instrumentation Blood Vessel Prosthesis Implantation - mortality Computed Tomography Angiography Endoleak - etiology Endovascular Procedures - adverse effects Endovascular Procedures - instrumentation Endovascular Procedures - mortality Female Florida Humans Kaplan-Meier Estimate Logistic Models Male Multivariate Analysis Odds Ratio Prosthesis Design Retrospective Studies Risk Factors Stents Time Factors Treatment Outcome |
| title | Configuration affects parallel stent grafting results |
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