Anatomical suitability of the T-branch stent-graft in patients with thoracoabdominal aortic aneurysms treated using custom-made multibranched endografts.

Abstract

PURPOSE:

To assess the anatomical suitability of the new off-the-shelf multibranched endograft (t-branch) in patients with thoracoabdominal aortic aneurysms (TAAA) previously treated by means of custom-made multibranched endografts.

METHODS:

Clinical and radiological data of 43 consecutive patients (34 men; mean age 72 years) with Crawford types I (n=1), II (n=16), III (n=18), or IV (n=8) TAAAs treated with custom-made multibranched endografts between June 2008 and February 2013 were retrospectively reviewed. Primary anatomical suitability of the t-branch device was assessed using 3-dimensional computed tomographic angiograms. Assisted suitability referred to the ability to use adjuvant procedures to eliminate anatomical obstacles that did not hinder the custom-made devices.

RESULTS:

Among the study group, 21 (49%) patients were suitable for treatment using the t-branch device. Another 6 (14%) would have been suitable with the assistance of additional maneuvers, such as thoracic endografting with (n=3) or without (n=3) left carotid-subclavian bypass. Sixteen (37%) patients violated the eligibility criteria due to a distance >56 cm between the celiac trunk and the most caudal renal artery (9, 60%), insufficient diameter (<25 mm) at the level of the visceral arteries (5, 33%), upward orientation of a renal artery (3, 20%), inadequate (>40 mm) proximal landing zone (2, 13%), and a distance <67 mm between the most caudal renal artery and aortic bifurcation (1, 7%).

CONCLUSION:

The t-branch stent-graft system would have been primarily suitable for implantation in half of the patients. With additional maneuvers, the assisted suitability reached 63%. Further optimization and refinement of the device will probably lead to a shift toward off-the-shelf multibranched stent-graft exclusion of TAAAs.

• Authors: Theodosios Bisdas, Konstantinos P Donas, Michel Bosiers, Giovanni Torsello, Martin Austermann
• Journal: Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists (J Endovasc Ther) Vol. 20 Issue 5 Pg. 672-7 (Oct 2013) ISSN: 1545-1550 [Electronic] United States
• PMID: 24093320 (Publication Type: Journal Article)

Topics

• Aged
• Aortic Aneurysm, Thoracic (diagnostic imaging, surgery)
• Aortography (methods)
• Blood Vessel Prosthesis
• Blood Vessel Prosthesis Implantation (adverse effects, instrumentation)
• Endovascular Procedures (adverse effects, instrumentation)
• Female
• Humans
• Male
• Patient Selection
• Predictive Value of Tests
• Prosthesis Design
• Retrospective Studies
• Stents
• Tomography, X-Ray Computed
• Treatment Outcome