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Branched Stentgrafts: Regional Multicentric Experience
Volume 38, January 2017
Abstracts accepted for presentation during the 31st Annual Meeting of the French Society for Vascular and Endovascular Surgery, Grenoble, June 24-27, 2016, President: Pr. Jean-Luc Magne
patients. But certain anatomical characteristics of the aorta restrict considerably the feasibility, the effectiveness and the durability of this technique. The technical choice in frail patients presenting anatomical contraindications for endovascular treatment remains debated. The objective of this study was to evaluate the results of open surgery in this category of patients. Materials and Methods: This retrospective study evaluated the results of the conventional scheduled treatment of AAAs in this category of patients between 2004 and 2014 in the regional university hospital. Symptomatic and non-degenerative aneurysms were excluded. 179 consecutive patients aged more than 80 years and/or presenting an ASA score >3 were included. Results: Mean age was 75 years. The average follow-up was 57 months. Mortality at D30 was 2.23%. Survival at five years was 76%. The factors influencing significantly the survival rate at five years were an age >80 years (p¼0.04); an increase in serum creatinine >20% at D2 (p¼0.02); a preoperative FEV1 <80% (p¼0.0009). The age >80 years and the increase in creatinine >20% at D2 were significantly predictive of short-term mortality (p¼0.0016). Conclusion: These results show an acceptable morbimortality despite the initial frailness of these patients. They justify the place of the conventional surgical treatment of AAAs in these high-risk patients which cannot benefit from endovascular treatment. http://dx.doi.org/10.1016/j.avsg.2016.07.053
HYBRID TREATMENT OF AORTIC ANEURYSMS ASSOCIATING BYPASSES ON THE RENAL/VISCERAL ARTERIES AND FENESTRATED/BRANCHED STENTGRAFTS: REGIONAL MULTICENTRIC EXPERIENCE Ambroise Duprey, Sabrina Ben Ahmed, Antoine Millon, Patrick Feugier, Jean-Pierre Favre, Eugenio Rosset, Patrick Lermusiaux, and Jean-No€el Albertini CHU de Lyon, CHU de Clermont-Ferrand, and CHU de SaintEtienne, France. Objectives: Fenestrated and branched stentgrafts allow the endovascular treatment of complex aortic aneurysms with satisfactory results. In some patients however the anatomy of the visceral arteries is not favorable to the use of a window or a branch. In this case, it is possible to choose a hybrid technique associating bypasses to one or more renal and/or digestive arteries, and the implantation of a fenestrated and/ se. The goal of this work was to or branched endoprothe
e27
describe the indications and the results of this hybrid technique. Materials and Methods: Between November 2005 and January 2016, 130 patients were treated in three centers by stentgrafts for an aneurysm of the juxta or suprarenal abdominal aorta (JSRA), or for a thoraco-abdominal aneurism (TAA). Eight patients had hybrid procedures with a bypass to a renal and/or digestive artery before the endovascular treatment. These procedures treated two JSRAs and six TAAs. Twelve bypasses were carried out including nine on the renal arteries (six ilio-renal and three hepatorenal) and three on the celiac trunk (one reno-hepatic bypass and two ilio-hepatic bypasses). Results: The indications of renal bypass were an important anteroposterior angulation (n¼2), an early bifurcation of the trunk (n¼2), the presence of a polar artery of diameter ranging between 3 and 5 mm (n¼3), an important angulation of the juxta-renal aorta (n¼1) and the location of the false-lumen entrance in a patient with an aortic dissection (n¼1). The indication for three bypasses to the celiac trunk was a tight stenosis. No patient died during a six months median follow-up (152 months). A rupture occurred on a thoracic proximal type I endoleak and was treated successfully with an extension. A renal branch feeding a reno-hepatic bypass was thrombosed at two years. The iliac portion of one ilio-reno-hepatic bypass was thrombosed at 15 months. A leak on a subclavian Amplatzer was re-embolized at 3 months. Conclusion: Hybrid procedures associating bypasses on the renal and/or digestive arteries with fenestrated or branched stentgrafts are realizable with acceptable results. This alternative is interesting when the anatomy of a renal and/or visceral artery is unfavorable with the use of a window or a branch. http://dx.doi.org/10.1016/j.avsg.2016.07.054
RENAL FUNCTION AFTER FENESTRATED OR BRANCHED AORTIC STENTGRAFTS: PREDICTIVE FACTORS OF EARLY DEGRADATION Meryl Favier de Lachomette, Nellie Della Schiava, Ambroise Duprey, Delphine Maucourt-Boulch, Eugenio Rosset, Patrick Feugier, Patrick Lermusiaux, Jean-No€el Albertini, and Antoine Millon Hospices Civils de Lyon, Lyon, Centre Hospitalier Universitaire de Clermont-Ferrand, and Centre Hospitalier Universitaire de Saint-Etienne, Saint-Priest-en-Jarez, France. Objectives: The aim of this study was to define predictive factors of early degradation of the renal function after the
Abstracts accepted for presentation during the 31st Annual Meeting of the French Society for Vascular and Endovascular Surgery, Grenoble, June 24-27, 2016, President: Pr. Jean-Luc Magne
patients. But certain anatomical characteristics of the aorta restrict considerably the feasibility, the effectiveness and the durability of this technique. The technical choice in frail patients presenting anatomical contraindications for endovascular treatment remains debated. The objective of this study was to evaluate the results of open surgery in this category of patients. Materials and Methods: This retrospective study evaluated the results of the conventional scheduled treatment of AAAs in this category of patients between 2004 and 2014 in the regional university hospital. Symptomatic and non-degenerative aneurysms were excluded. 179 consecutive patients aged more than 80 years and/or presenting an ASA score >3 were included. Results: Mean age was 75 years. The average follow-up was 57 months. Mortality at D30 was 2.23%. Survival at five years was 76%. The factors influencing significantly the survival rate at five years were an age >80 years (p¼0.04); an increase in serum creatinine >20% at D2 (p¼0.02); a preoperative FEV1 <80% (p¼0.0009). The age >80 years and the increase in creatinine >20% at D2 were significantly predictive of short-term mortality (p¼0.0016). Conclusion: These results show an acceptable morbimortality despite the initial frailness of these patients. They justify the place of the conventional surgical treatment of AAAs in these high-risk patients which cannot benefit from endovascular treatment. http://dx.doi.org/10.1016/j.avsg.2016.07.053
HYBRID TREATMENT OF AORTIC ANEURYSMS ASSOCIATING BYPASSES ON THE RENAL/VISCERAL ARTERIES AND FENESTRATED/BRANCHED STENTGRAFTS: REGIONAL MULTICENTRIC EXPERIENCE Ambroise Duprey, Sabrina Ben Ahmed, Antoine Millon, Patrick Feugier, Jean-Pierre Favre, Eugenio Rosset, Patrick Lermusiaux, and Jean-No€el Albertini CHU de Lyon, CHU de Clermont-Ferrand, and CHU de SaintEtienne, France. Objectives: Fenestrated and branched stentgrafts allow the endovascular treatment of complex aortic aneurysms with satisfactory results. In some patients however the anatomy of the visceral arteries is not favorable to the use of a window or a branch. In this case, it is possible to choose a hybrid technique associating bypasses to one or more renal and/or digestive arteries, and the implantation of a fenestrated and/ se. The goal of this work was to or branched endoprothe
e27
describe the indications and the results of this hybrid technique. Materials and Methods: Between November 2005 and January 2016, 130 patients were treated in three centers by stentgrafts for an aneurysm of the juxta or suprarenal abdominal aorta (JSRA), or for a thoraco-abdominal aneurism (TAA). Eight patients had hybrid procedures with a bypass to a renal and/or digestive artery before the endovascular treatment. These procedures treated two JSRAs and six TAAs. Twelve bypasses were carried out including nine on the renal arteries (six ilio-renal and three hepatorenal) and three on the celiac trunk (one reno-hepatic bypass and two ilio-hepatic bypasses). Results: The indications of renal bypass were an important anteroposterior angulation (n¼2), an early bifurcation of the trunk (n¼2), the presence of a polar artery of diameter ranging between 3 and 5 mm (n¼3), an important angulation of the juxta-renal aorta (n¼1) and the location of the false-lumen entrance in a patient with an aortic dissection (n¼1). The indication for three bypasses to the celiac trunk was a tight stenosis. No patient died during a six months median follow-up (152 months). A rupture occurred on a thoracic proximal type I endoleak and was treated successfully with an extension. A renal branch feeding a reno-hepatic bypass was thrombosed at two years. The iliac portion of one ilio-reno-hepatic bypass was thrombosed at 15 months. A leak on a subclavian Amplatzer was re-embolized at 3 months. Conclusion: Hybrid procedures associating bypasses on the renal and/or digestive arteries with fenestrated or branched stentgrafts are realizable with acceptable results. This alternative is interesting when the anatomy of a renal and/or visceral artery is unfavorable with the use of a window or a branch. http://dx.doi.org/10.1016/j.avsg.2016.07.054
RENAL FUNCTION AFTER FENESTRATED OR BRANCHED AORTIC STENTGRAFTS: PREDICTIVE FACTORS OF EARLY DEGRADATION Meryl Favier de Lachomette, Nellie Della Schiava, Ambroise Duprey, Delphine Maucourt-Boulch, Eugenio Rosset, Patrick Feugier, Patrick Lermusiaux, Jean-No€el Albertini, and Antoine Millon Hospices Civils de Lyon, Lyon, Centre Hospitalier Universitaire de Clermont-Ferrand, and Centre Hospitalier Universitaire de Saint-Etienne, Saint-Priest-en-Jarez, France. Objectives: The aim of this study was to define predictive factors of early degradation of the renal function after the