Universität zu Köln

de Niet, Arne ORCID: 0000-0001-8830-863X, Reijnen, Michel M. P. J., Zeebregts, Clark J., Falkensammer, J., Kotelis, D., Mylonas, S., Brunkwall, J., Geelkerken, R. H., Meerwaldt, R., Gimenez-Gaibar, A., Papaioannou, A., Pfister, K., Kasprzak, P., Reijnen, M. M. P. J., Lardenoije, J. W. H. P., Williams, R., Delbridge, M., Fadda, G. F., Martinez, R., Rouhani, G., Rylski, B., Verhagen, H. J. M., Zeebregts, C. J., Tielliu, I. F. J. and de Niet, A. (2019). Early results with the custom-made Fenestrated Anaconda aortic cuff in the treatment of complex abdominal aortic aneurysm. J. Vasc. Surg., 69 (2). S. 348 - 357. NEW YORK: MOSBY-ELSEVIER. ISSN 0741-5214

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Abstract

Objective: The objective of this study was to investigate the feasibility of a specific custom-made fenestrated aortic cuff in the treatment of complex abdominal aortic aneurysms (AAAs). Methods: Between 2013 and 2016, a total of 57 custom-made Fenestrated Anaconda (Vascutek, Inchinnan, Scotland, UK) aortic cuffs were placed in 38 centers worldwide. All centers were invited to participate in this retrospective analysis. Postoperative and follow-up data included the presence of adverse events, necessity for reintervention, and renal function. Results: Fifteen clinics participated, leading to 29 cases. Median age at operation was 74 years (interquartile range [IQR], 71-78 years); five patients were female. Two patients were treated for a para-anastomotic AAA after open AAA repair, 19 patients were treated because of a complicated course after primary endovascular AAA repair, and 8 cases were primary procedures for AAA. A total of 76 fenestrations (mean, 2.6 per case) were used. Four patients needed seven adjunctive procedures. Two patients underwent conversion, one because of a dissection of the superior mesenteric artery and one because of perforation of a renal artery. Median operation time was 225 minutes (IQR, 150-260 minutes); median blood loss, 200 mL (IQR, 100-500 mL); and median contrast volume, 150 mL (IQR, 92-260 mL). Primary technical success was achieved in 86% and secondary technical success in 93%. The 30-day morbidity was 7 of 29 with amortality rate of 4 of 29. Estimated glomerular filtration rate remained unchanged before and after surgery (76 to 77 mL/min/m(2)). Between preoperative and median follow-up of 11 months, estimated glomerular filtration rate was reduced statistically significantly (76 to 63 mL/min/m(2)). During follow-up, 9 cases had an increase in aneurysm sac diameter (5 cases > 5 mm); 14 cases had a stable or decreased aneurysm sac diameter; and in 2 cases, no aneurysm size was reported. No type I endoleak was reported, and two cases with a type III endoleak were treated by endovascular means during follow-up. Survival, reintervention-free survival, and target vessel patency at 1 year were 81% +/- 8%, 75% +/- 9%, and 99% +/- 1%, respectively. After 2 years, these numbers were 81% +/- 8%, 67% +/- 11%, and 88% +/- 6%, respectively. During follow-up, the two patients with a type III endoleak needed endograft-related reinterventions. Conclusions: Treatment with this specific custom-made fenestrated aortic cuff is feasible after complicated previous (endovascular) aortic repair or in complex AAAs. The complexity of certain AAA cases is underlined in this study, and the Fenestrated Anaconda aortic cuff is a valid option in selected cases in which few treatment options are left.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code de Niet, Arne UNSPECIFIED orcid.org/0000-0001-8830-863X UNSPECIFIED Reijnen, Michel M. P. J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Zeebregts, Clark J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Falkensammer, J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kotelis, D. UNSPECIFIED UNSPECIFIED UNSPECIFIED Mylonas, S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Brunkwall, J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Geelkerken, R. H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Meerwaldt, R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Gimenez-Gaibar, A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Papaioannou, A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Pfister, K. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kasprzak, P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Reijnen, M. M. P. J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Lardenoije, J. W. H. P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Williams, R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Delbridge, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Fadda, G. F. UNSPECIFIED UNSPECIFIED UNSPECIFIED Martinez, R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Rouhani, G. UNSPECIFIED UNSPECIFIED UNSPECIFIED Rylski, B. UNSPECIFIED UNSPECIFIED UNSPECIFIED Verhagen, H. J. M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Zeebregts, C. J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Tielliu, I. F. J. UNSPECIFIED UNSPECIFIED UNSPECIFIED de Niet, A. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-158359
DOI:	10.1016/j.jvs.2018.05.218
Journal or Publication Title:	J. Vasc. Surg.
Volume:	69
Number:	2
Page Range:	S. 348 - 357
Date:	2019
Publisher:	MOSBY-ELSEVIER
Place of Publication:	NEW YORK
ISSN:	0741-5214
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ENDOVASCULAR REPAIR; STENT-GRAFTS; ENDOGRAFT; ENDOLEAK; COMPLICATIONS; DURABILITY; EXPERIENCE; MIGRATION; OUTCOMES; EVAR Multiple languages Surgery; Peripheral Vascular Disease Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/15835