Fenestrated and branched stent grafts for the treatment of post-dissection thoracoabdominal aortic aneurysms

Abstract

The present study aims to analyze fenestrated/branched endovascular aneurysm repair (F/BEVAR) in the treatment of post-dissection thoracoabdominal aortic aneurysms (PD-TAAAs). Focus is given on indication, anatomic suitability, device planning, and clinical outcomes. PD-TAAAs present with additional challenges in F/BEVAR. These include true lumen compression and visceral arteries originating from the false lumen. These technical challenges limited the use of F/BEVAR in PD-TAAAs to a few institutions in the beginning, but the good results reported with this approach have led to an increase in its use in a growing number of centers. Our current single-center experience includes 75 patients treated with F/BEVAR for a PD-TAAA between October 2010 and October 2021. Technical success was achieved in 74 cases (98.7%). Two patients (2.6%) died in the first 30 postoperative days. Ten patients (13.3%) had postoperative symptoms of spinal cord ischemia: 9 (12%) with transient limb weakness and 1 (1.3%) with permanent paraplegia. There was only 1 death (1.3%) related to the aneurysm during follow-up. Mean ± SD estimated primary patency rates of the target vessels at 12, 24, and 36 months were 97.9% ± 1%, 96.1% ± 1.6%, and 95.2% ± 1.9%, respectively. The estimated freedom from re-intervention rates at these time points were 81.4% ± 5.3%, 56.9% ± 7.3%, and 53.9% ± 7.5%, respectively. In conclusion, F/BEVAR can be performed in PD-TAAAs with high rates of technical success and good mid-term results with regard to mortality and morbidity. The additional technical challenges posed by PD-TAAAs need to be considered to prevent complications and decrease the high rate of re-interventions.