Huistra, Emiel W.M. (2024) Clinical and technical outcomes of endovascular aneurysm repair with a contralateral inverted limb A retrospective study in a tertiary care center. thesis, Medicine.
Full text available on request.Abstract
Objective. To report technical success and evaluate clinical outcomes of fenestrated and branched endovascular aortic repair (F/B-EVAR) incorporating a contralateral inverted limb. Methods. All 32 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. Results. 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. One patient (3.1%) died <30 days post-operatively. 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 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 arose from fenestrations at the level of the renal stents. There were no junctional problems between the inverted limb device and the main endograft. Conclusion. F/B-EVAR incorporating a contralateral inverted limb can be a viable endovascular option to manage complex aneurysms with a short renal-artery to bifurcation distance. Carefully protecting the renal arteries and confirming correct cannulation of the inverted limb is warranted.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Prof. Dr. Zeebregts, Clark J. and Dr. Tielliu, Ignace F.J. |
| Date Deposited: | 08 Oct 2024 12:59 |
| Last Modified: | 08 Oct 2024 12:59 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3764 |
Actions (login required)
 |
View Item |