Outcomes of fenestrated and branched endovascular aneurysm repair with an inverted contralateral limb
To report technical success and evaluate clinical outcomes of fenestrated and branched endovascular aortic repair (F/B-EVAR) incorporating a contralateral inverted limb. Patients who underwent F/B-EVAR with a custom-made bifurcated device containing an inverted limb between January 2010 and Septembe...
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| Veröffentlicht in: | Journal of vascular surgery 2025-01, Vol.81 (1), p.46-54.e1 |
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| creator | Huistra, Emiel W.M. Tielliu, Ignace F.J. de Vries, Jean-Paul P.M. Zeebregts, Clark J. |
| description | To report technical success and evaluate clinical outcomes of fenestrated and branched endovascular aortic repair (F/B-EVAR) incorporating a contralateral inverted limb.
Patients who underwent F/B-EVAR with a custom-made bifurcated device containing an inverted limb between January 2010 and September 2023 were retrospectively analyzed. Time-to-event data were analyzed using the Kaplan-Meier method.
A total of 32 patients (26 men; mean age 77±6.2 years) were included in the analysis. Technical success was achieved in 28 patients (87.5%). Two technical failures resulted from misplaced contralateral limbs in patients with previous endovascular aortic repair (EVAR), necessitating one open conversion due to a type 3b endoleak, and one femoro-femoral crossover bypass after occlusion of a misplaced contralateral limb. Additionally, two technical failures were attributed to a type 3c endoleak and a type 1c endoleak, originating from a fenestrated device at the level of the left and right renal artery, respectively. One patient (3.1%) died |
| doi_str_mv | 10.1016/j.jvs.2024.07.110 |
| format | Article |
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Patients who underwent F/B-EVAR with a custom-made bifurcated device containing an inverted limb between January 2010 and September 2023 were retrospectively analyzed. Time-to-event data were analyzed using the Kaplan-Meier method.
A total of 32 patients (26 men; mean age 77±6.2 years) were included in the analysis. Technical success was achieved in 28 patients (87.5%). Two technical failures resulted from misplaced contralateral limbs in patients with previous endovascular aortic repair (EVAR), necessitating one open conversion due to a type 3b endoleak, and one femoro-femoral crossover bypass after occlusion of a misplaced contralateral limb. Additionally, two technical failures were attributed to a type 3c endoleak and a type 1c endoleak, originating from a fenestrated device at the level of the left and right renal artery, respectively. One patient (3.1%) died <30 days post-operatively due to a subdural hemorrhage. Estimated patient survival after 1 and 2 years was 92.7%±5.1%, and 74.3%±10.1%, respectively. No aneurysm-related deaths were observed. During the median follow-up of 13 months, one (3.1%) inverted limb occluded, in addition to the occlusion resulting from a misplaced contralateral limb, and was treated with a femoro-femoral crossover bypass. One target vessel (right renal artery) occluded (0.9%), resulting in a permanent, significantly reduced renal function. Freedom from overall reintervention after 1 and 2 years was 73.5%±8.0% and 68.3%±9.0%, respectively. An additional four patients (12.5%) presented with a type 3c endoleak during follow-up scans, three of which originated from fenestrations at the level of the renal stents. There were no junctional problems between the inverted limb device and the main endograft, and no significant correlation was found between the one-sealing-stent inverted limb device design and the onset of type 3 endoleak (log-rank P=.064).
F/B-EVAR incorporating an inverted limb can be a viable endovascular option to manage complex aneurysms with a short renal artery to bifurcation distance. However, using the inverted limb presents a notable technical challenge and could be associated with a higher need for reintervention. Carefully confirming correct cannulation of the inverted limb is warranted.</description><identifier>ISSN: 0741-5214</identifier><identifier>ISSN: 1097-6809</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/j.jvs.2024.07.110</identifier><identifier>PMID: 39303861</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Abdominal aortic aneurysm ; Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal - diagnostic imaging ; Aortic Aneurysm, Abdominal - mortality ; Aortic Aneurysm, Abdominal - surgery ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation - adverse effects ; Blood Vessel Prosthesis Implantation - instrumentation ; Blood Vessel Prosthesis Implantation - mortality ; Branched endografts ; Endoleak - etiology ; Endoleak - surgery ; Endovascular Aneurysm Repair ; Endovascular aortic repair ; Endovascular Procedures - adverse effects ; Endovascular Procedures - instrumentation ; Endovascular Procedures - mortality ; Female ; Fenestrated endografts ; Humans ; Inverted contralateral (iliac) limb ; Male ; Postoperative Complications - etiology ; Postoperative Complications - surgery ; Prosthesis Design ; Retrospective Studies ; Risk Factors ; Stents ; Time Factors ; Treatment Outcome</subject><ispartof>Journal of vascular surgery, 2025-01, Vol.81 (1), p.46-54.e1</ispartof><rights>2024 The Authors</rights><rights>Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c278t-94647b24e0e7d676669404e84b6e8918d39f4e4a620a4f90c9a51ee204184c353</cites><orcidid>0000-0002-6758-1933</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jvs.2024.07.110$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3541,27915,27916,45986</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39303861$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Huistra, Emiel W.M.</creatorcontrib><creatorcontrib>Tielliu, Ignace F.J.</creatorcontrib><creatorcontrib>de Vries, Jean-Paul P.M.</creatorcontrib><creatorcontrib>Zeebregts, Clark J.</creatorcontrib><title>Outcomes of fenestrated and branched endovascular aneurysm repair with an inverted contralateral limb</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>To report technical success and evaluate clinical outcomes of fenestrated and branched endovascular aortic repair (F/B-EVAR) incorporating a contralateral inverted limb.
Patients who underwent F/B-EVAR with a custom-made bifurcated device containing an inverted limb between January 2010 and September 2023 were retrospectively analyzed. Time-to-event data were analyzed using the Kaplan-Meier method.
A total of 32 patients (26 men; mean age 77±6.2 years) were included in the analysis. Technical success was achieved in 28 patients (87.5%). Two technical failures resulted from misplaced contralateral limbs in patients with previous endovascular aortic repair (EVAR), necessitating one open conversion due to a type 3b endoleak, and one femoro-femoral crossover bypass after occlusion of a misplaced contralateral limb. Additionally, two technical failures were attributed to a type 3c endoleak and a type 1c endoleak, originating from a fenestrated device at the level of the left and right renal artery, respectively. One patient (3.1%) died <30 days post-operatively due to a subdural hemorrhage. Estimated patient survival after 1 and 2 years was 92.7%±5.1%, and 74.3%±10.1%, respectively. No aneurysm-related deaths were observed. During the median follow-up of 13 months, one (3.1%) inverted limb occluded, in addition to the occlusion resulting from a misplaced contralateral limb, and was treated with a femoro-femoral crossover bypass. One target vessel (right renal artery) occluded (0.9%), resulting in a permanent, significantly reduced renal function. Freedom from overall reintervention after 1 and 2 years was 73.5%±8.0% and 68.3%±9.0%, respectively. An additional four patients (12.5%) presented with a type 3c endoleak during follow-up scans, three of which originated from fenestrations at the level of the renal stents. There were no junctional problems between the inverted limb device and the main endograft, and no significant correlation was found between the one-sealing-stent inverted limb device design and the onset of type 3 endoleak (log-rank P=.064).
F/B-EVAR incorporating an inverted limb can be a viable endovascular option to manage complex aneurysms with a short renal artery to bifurcation distance. However, using the inverted limb presents a notable technical challenge and could be associated with a higher need for reintervention. Carefully confirming correct cannulation of the inverted limb is warranted.</description><subject>Abdominal aortic aneurysm</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aortic Aneurysm, Abdominal - diagnostic imaging</subject><subject>Aortic Aneurysm, Abdominal - mortality</subject><subject>Aortic Aneurysm, Abdominal - surgery</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>Branched endografts</subject><subject>Endoleak - etiology</subject><subject>Endoleak - surgery</subject><subject>Endovascular Aneurysm Repair</subject><subject>Endovascular aortic repair</subject><subject>Endovascular Procedures - adverse effects</subject><subject>Endovascular Procedures - instrumentation</subject><subject>Endovascular Procedures - mortality</subject><subject>Female</subject><subject>Fenestrated endografts</subject><subject>Humans</subject><subject>Inverted contralateral (iliac) limb</subject><subject>Male</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - surgery</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><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2025</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMtO5DAQRS00CJrHB7BBWc4moSpx_BArhHhJSGxgbTlORbiVR2MnPeLvcathlmxs2b73yHUYu0AoEFBcrYv1NhYllLwAWSDCAVshaJkLBfoPW4HkmNcl8mN2EuMaALFW8ogdV7qCSglcMXpZZjcNFLOpyzoaKc7BztRmdmyzJtjRvacDje20tdEtvQ3phZbwGYcs0Mb6kP3z83u6zPy4pbCrumlMkD5h0pr1fmjO2GFn-0jn3_spe7u_e719zJ9fHp5ub55zV0o155oLLpuSE5BshRRCaA6cFG8EKY2qrXTHiVtRguWdBqdtjUQlcFTcVXV1yv7uuZswfSxpFjP46Kjv05-nJZoKQdYgKqVSFPdRF6YYA3VmE_xgw6dBMDu7Zm2SXbOza0CaZDd1Lr_xSzNQ-7_xozMFrvcBSkNuPQUTnafRUesDudm0k_8F_wUfZotV</recordid><startdate>202501</startdate><enddate>202501</enddate><creator>Huistra, Emiel W.M.</creator><creator>Tielliu, Ignace F.J.</creator><creator>de Vries, Jean-Paul P.M.</creator><creator>Zeebregts, Clark J.</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><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><orcidid>https://orcid.org/0000-0002-6758-1933</orcidid></search><sort><creationdate>202501</creationdate><title>Outcomes of fenestrated and branched endovascular aneurysm repair with an inverted contralateral limb</title><author>Huistra, Emiel W.M. ; Tielliu, Ignace F.J. ; de Vries, Jean-Paul P.M. ; Zeebregts, Clark J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c278t-94647b24e0e7d676669404e84b6e8918d39f4e4a620a4f90c9a51ee204184c353</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2025</creationdate><topic>Abdominal aortic aneurysm</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aortic Aneurysm, Abdominal - diagnostic imaging</topic><topic>Aortic Aneurysm, Abdominal - mortality</topic><topic>Aortic Aneurysm, Abdominal - surgery</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>Branched endografts</topic><topic>Endoleak - etiology</topic><topic>Endoleak - surgery</topic><topic>Endovascular Aneurysm Repair</topic><topic>Endovascular aortic repair</topic><topic>Endovascular Procedures - adverse effects</topic><topic>Endovascular Procedures - instrumentation</topic><topic>Endovascular Procedures - mortality</topic><topic>Female</topic><topic>Fenestrated endografts</topic><topic>Humans</topic><topic>Inverted contralateral (iliac) limb</topic><topic>Male</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - surgery</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>Huistra, Emiel W.M.</creatorcontrib><creatorcontrib>Tielliu, Ignace F.J.</creatorcontrib><creatorcontrib>de Vries, Jean-Paul P.M.</creatorcontrib><creatorcontrib>Zeebregts, Clark J.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><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>Huistra, Emiel W.M.</au><au>Tielliu, Ignace F.J.</au><au>de Vries, Jean-Paul P.M.</au><au>Zeebregts, Clark J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes of fenestrated and branched endovascular aneurysm repair with an inverted contralateral limb</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2025-01</date><risdate>2025</risdate><volume>81</volume><issue>1</issue><spage>46</spage><epage>54.e1</epage><pages>46-54.e1</pages><issn>0741-5214</issn><issn>1097-6809</issn><eissn>1097-6809</eissn><abstract>To report technical success and evaluate clinical outcomes of fenestrated and branched endovascular aortic repair (F/B-EVAR) incorporating a contralateral inverted limb.
Patients who underwent F/B-EVAR with a custom-made bifurcated device containing an inverted limb between January 2010 and September 2023 were retrospectively analyzed. Time-to-event data were analyzed using the Kaplan-Meier method.
A total of 32 patients (26 men; mean age 77±6.2 years) were included in the analysis. Technical success was achieved in 28 patients (87.5%). Two technical failures resulted from misplaced contralateral limbs in patients with previous endovascular aortic repair (EVAR), necessitating one open conversion due to a type 3b endoleak, and one femoro-femoral crossover bypass after occlusion of a misplaced contralateral limb. Additionally, two technical failures were attributed to a type 3c endoleak and a type 1c endoleak, originating from a fenestrated device at the level of the left and right renal artery, respectively. One patient (3.1%) died <30 days post-operatively due to a subdural hemorrhage. Estimated patient survival after 1 and 2 years was 92.7%±5.1%, and 74.3%±10.1%, respectively. No aneurysm-related deaths were observed. During the median follow-up of 13 months, one (3.1%) inverted limb occluded, in addition to the occlusion resulting from a misplaced contralateral limb, and was treated with a femoro-femoral crossover bypass. One target vessel (right renal artery) occluded (0.9%), resulting in a permanent, significantly reduced renal function. Freedom from overall reintervention after 1 and 2 years was 73.5%±8.0% and 68.3%±9.0%, respectively. An additional four patients (12.5%) presented with a type 3c endoleak during follow-up scans, three of which originated from fenestrations at the level of the renal stents. There were no junctional problems between the inverted limb device and the main endograft, and no significant correlation was found between the one-sealing-stent inverted limb device design and the onset of type 3 endoleak (log-rank P=.064).
F/B-EVAR incorporating an inverted limb can be a viable endovascular option to manage complex aneurysms with a short renal artery to bifurcation distance. However, using the inverted limb presents a notable technical challenge and could be associated with a higher need for reintervention. Carefully confirming correct cannulation of the inverted limb is warranted.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>39303861</pmid><doi>10.1016/j.jvs.2024.07.110</doi><orcidid>https://orcid.org/0000-0002-6758-1933</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Abdominal aortic aneurysm Aged Aged, 80 and over Aortic Aneurysm, Abdominal - diagnostic imaging Aortic Aneurysm, Abdominal - mortality Aortic Aneurysm, Abdominal - surgery Blood Vessel Prosthesis Blood Vessel Prosthesis Implantation - adverse effects Blood Vessel Prosthesis Implantation - instrumentation Blood Vessel Prosthesis Implantation - mortality Branched endografts Endoleak - etiology Endoleak - surgery Endovascular Aneurysm Repair Endovascular aortic repair Endovascular Procedures - adverse effects Endovascular Procedures - instrumentation Endovascular Procedures - mortality Female Fenestrated endografts Humans Inverted contralateral (iliac) limb Male Postoperative Complications - etiology Postoperative Complications - surgery Prosthesis Design Retrospective Studies Risk Factors Stents Time Factors Treatment Outcome |
| title | Outcomes of fenestrated and branched endovascular aneurysm repair with an inverted contralateral limb |
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