Early Limb Reperfusion Using Routinely Preloaded Fenestrated Stent-graft Designs for Complex Endovascular Aortic Procedu
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CLINICAL INVESTIGATION
ARTERIAL INTERVENTIONS
Early Limb Reperfusion Using Routinely Preloaded Fenestrated Stent-graft Designs for Complex Endovascular Aortic Procedures Luca Bertoglio1 • Diletta Loschi1 • Alessandro Grandi1 Victor Bilman1 • Germano Melissano1 • Roberto Chiesa1
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Andrea Melloni1
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Received: 5 May 2020 / Accepted: 4 July 2020 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Abstract Introduction To evaluate the outcomes of the preloaded stent-graft design (PLD) in the routine treatment of pararenal and thoraco-abdominal aneurysms compared to the standard design (SND). Methods Patients treated by fenestrated/branched endovascular aneurysm repair from 2013 were collected. Since 2017, PLD (23F delivery system) was implemented in our standard practice and the outcomes are reported. Primary outcome measurements were: technical success, 30-day adverse events, leg ischemia time, procedural time and radiation exposure. Secondary outcome measurements were: intraoperative urinary output, need of bicarbonate
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00270-020-02596-1) contains supplementary material, which is available to authorized users. & Luca Bertoglio [email protected] Diletta Loschi [email protected] Alessandro Grandi [email protected] Andrea Melloni [email protected] Victor Bilman [email protected]
supplementation, postoperative biomarkers elevations and need for blood transfusions. A propensity 1:1 matching for graft design and aneurysm extent was performed with the SND (18F delivery system) cohort to highlight possible PLD advantages. Results A PLD was employed in 32 non-consecutive patients with a technical and clinical success rate of 100% and 81% respectively: no mortality was recorded. The Society for Vascular Surgery grade C 1 adverse event was observed in 10 cases (31%): five temporary paraparesis were observed. Seventeen PLD patients were matched. The procedural time was shorter in PLD group (266 vs. 390 min; p = 0.001) as well as fluoroscopy time (68 vs. 96 min; p = 0.019) and contrast media used (180 vs. 382 ml; p = 0.045). Contralateral limb ischemic time was significantly higher in SND group (0 vs. 70 min; p = 0.042). The need for blood transfusion and the postoperative peak of creatine phosphokinase was lower in PLD group (151 vs. 449 U/l; p \ 0.001). Conclusions Preloaded stent-graft design allows a unifemoral approach in the majority of the interventions reducing procedural times and the ischemia on the contralateral leg, leading to possible benefits. Keywords Thoraco-abdominal aneurysms Fenestrated Branched Endovascular Spinal cord Paraplegia Limb Ischemia
Germano Melissano [email protected] Roberto Chiesa [email protected] 1
San Raffaele Scientific Institute, ‘‘Vita-Salute’’ University School of Medicine, Milano, Italy
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L. Bertoglio et al.: Early Limb Reperfusion Using Routi
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