Three Year Data on the Performance of Three Renal Artery Bridging Stent Grafts in Branched Endovascular Repair of Thoraco-Abdominal Pathologies

Abstract

Objective: Previous studies have shown that branched endovascular aneurysm repair (B-EVAR) carries a significant risk of adverse renal events. The purpose of this study was to evaluate the performance of the balloon expandable covered stentgraft (BECS) Advanta/iCast V12, the Viabahn balloon expandable stent (VBX), and the BECS Advanta stent combined with a distally deployed self expanding covered stentgraft (SECS) Viabahn (VSX) as bridging stent grafts (BSGs) in renal arteries.

Methods: A retrospective analysis of prospectively collected data was conducted at a single centre. Patients undergoing B-EVAR who had at least one Advanta, Advanta + VSX, or VBX as renal artery BSGs were included. Endpoints were patency, endoleaks, target vessel instability (TVI), re-interventions, as well as clinical outcomes including kidney function, new dialysis needs, and death. Data were analysed using Kaplan-Meier estimates and multivariable Cox regression.

Results: The study included 255 patients with 431 renal artery BSGs treated by complex aortic repair between 2010 and 2019. Advanta was used predominantly in 2010 - 2014, Advanta + VSX in 2015 - 2017, and VBX in 2018 - 2019. Overall, 125 Advanta, 146 Advanta + VSX, and 160 VBX stents were implanted. The median follow up was 19.3 months. At three years, estimated primary patencies were 82.7 ± 4.6% for renal arteries treated with Advanta, 96.8 ± 1.8% for Advanta + VSX, and 89.0 ± 3.2% for VBX. Estimated freedom from TVI at three years was 82.4 ± 4.7% for renal arteries treated with Advanta, 94.1 ± 2.4% for Advanta + VSX, and 85.4 ± 3.5% for VBX. Freedom from re-intervention estimations at three years were 86.3 ± 3.4% in the Advanta cohort, 95.1 ± 2.0% in the Advanta + VSX cohort, and 91.6 ± 2.4% in the VBX cohort.

Conclusion: The combination of BECS and SECS seems to be superior in terms of primary patency compared with BECS alone.

Keywords: B-EVAR; Balloon expandable stents; Bridging stents; Renal arteries; Self expandable stents.