Multicenter Experience With Large Diameter Balloon-Expandable Stent-Grafts for the Treatment of Infrarenal Penetrating Aortic Ulcers.

Abstract

PURPOSE:

To describe the use of large-diameter balloon-expandable stent-grafts (BeGraft aortic stent-graft, Bentley InnoMed GmbH, Hechingen, Germany) in the treatment of infrarenal penetrating aortic ulcer (iPAU).

MATERIALS AND METHODS:

Retrospective analysis of patients undergoing endovascular treatment with the BeGraft aortic stent-graft in 8 European centers from January 2017 to October 2020. Demographics, perioperative data, and midterm outcomes were collected. Endpoints of the study were technical feasibility, early mortality, and morbidity.

RESULTS:

A total of 40 patients were included. The mean age was 73.9±7.05 years and 63.2% were male. Indications for treatment included size and morphology (65%), presence of symptoms (29.5%), and contained ruptures (5.5%). Urgent treatment was performed in 5% of cases. Technical success was 97.5%. Median operation time was 58 minutes (19-170 minutes), with 27.5% of patients having additional procedures during the main intervention (1 additional repair with a C-TAG (W.L. Gore & Associates, Inc, Flagstaff, AZ, USA) thoracic endoprosthesis, 5 covered endovascular reconstruction of aortic bifurcation procedures, 3 extensions with proximal cuffs, and 2 percutaneous angioplasties of the common iliac arteries). Percutaneous femoral access was used in 72.5%, while groin cut-down was performed in 27.5%. Repair was successful with only 1 stent in 45% of cases, while 37.5% required 2 stents and nearly 17.5% required 3/4 stent-grafts. The 30-day mortality was 0%, with a 2.5% reintervention rate (1 patient required evacuation of an intra-abdominal hematoma). Median follow-up was 13.9 months (2-39 months), during which no vascular-related reinterventions or deaths were reported. In 4 patients, a type II endoleak was observed. No cases of graft migration, thrombosis, or stent-fracture were observed.

CONCLUSIONS:

The treatment of iPAU with the BeGraft aortic stent-graft in a selective patient group is feasible with low rate of perioperative morbidity and mortality. Balloon-expandable stent-grafts offer the option to repair iPAUs with a shorter coverage of the aorta using low-profile sheath, that enables treatment in the presence of calcified access vessels and small diameter aortic bifurcations.

• Authors: Jan Stana, Carlota Fernandez Prendes, Lukasz Kruszyna, Ioannis Thomas Passaloglou, Maria Antonella Ruffino, Andres Reyes Valdivia, Jose Antonio Del Castro Madrazo, Kyriakos Oikonomou, Hon Lai Chan, Vladimir Makaloski, Nikolaos Tsilimparis
• Journal: Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists (J Endovasc Ther) Vol. 28 Issue 6 Pg. 871-877 (Dec 2021) ISSN: 1545-1550 [Electronic] United States
• PMID: 34190634 (Publication Type: Journal Article, Multicenter Study)

Topics

• Aged
• Aged, 80 and over
• Blood Vessel Prosthesis
• Blood Vessel Prosthesis Implantation (adverse effects)
• Endovascular Procedures (adverse effects)
• Humans
• Male
• Prosthesis Design
• Retrospective Studies
• Stents
• Treatment Outcome
• Ulcer (diagnostic imaging, surgery)