Use of an Off the Shelf Inner Branch Thoraco-abdominal Endograft for the Treatment of Juxtarenal and Pararenal Aortic Aneurysms
Francesco Squizzato, Michele Piazza, Giacomo Isernia, Giovanni Pratesi, Emanuele Gatta, Michelangelo Ferri, Yamume Tshomba, Roberto Gattuso, Gian Franco Veraldi, Michele Antonello, Michele Antonello, Michele Piazza, Francesco Squizzato, Matteo Spezia, Giovanni Pratesi, Giovanni Spinella, Davide Esposito, Martina Bastianon, Davide Esposito, Yamume Tshomba, Tommaso Donati, Simona Sica, Giovanni Tinelli, Michelangelo Ferri, Simone Quaglino, Andrea Gaggiano, Vincenzo Vento, Luciano Carbonari, Emanuele Gatta, Massimo Lenti, Gioele Simonte, Giacomo Isernia, Giambattista Parlani, Gabriele Piffaretti, Paolo Frigatti, Paola Scrivere, Federico Furlan, Gian Franco Veraldi, Luca Mezzetto, Stefano Gennai, Nicola Leone, Roberto Silingardi, Gustavo Iacono, Giorgio Ubaldo Turricchia, Domenico Angiletta, Massimo Maione, Dimitri Apostolou, Raffaele Pulli, Aaron Fargion, Federico Filippi, Filippo De Angelis, Vittorio Arici, Antonio Bozzani, Alessandro Carlo Luigi Molinari, Giovanni Rossi, Emidio Costantini Brancadoro, Matteo Ferraris, Vittorio Dorrucci, Graziana Derone, Valerio Stefano Tolva, Nicola Monzio Compagnoni, Vittorio Maria Segramora, Gaetano Deleo, Umberto Bracale, Davide Turchino, Giuseppe Guzzardi, Ciro Ferrer, Rocco Giudice, Enrico Sbarigia, Simone Cuozzo, Roberto Gattuso, Wassim Mansour, Luca Di Marzo, Sabrina Grimaldi, Mario Corona, Emiliano Chisci, Stefano Mechelagnoli, Gianmarco De Donato, Giancarlo Palasciano, Edoardo Pasqui, Laura Candeloro, Carmelo Ricci, Eugenio Neri, Nicola Mangialardi, Matteo Orrico, Sonia Ronchey, Stefano Fazzini, Arnaldo Ippoliti, Andrea Discalzi, Denis Rossato, Elias Vio, Edoardo Galeazzi, Fabrizio Farneti, Stefano Bonardelli, Luca Bertoglio, Andrea Melloni, Alessandro Grandi, Pietro Volpe, Mafalda Massara, Domenico Milite
Abstract
OBJECTIVE: To investigate outcomes of an off the shelf pre-loaded inner branched endograft (E-nside) for the treatment of juxtarenal and pararenal abdominal aortic aneurysms (JP-AAAs). METHODS: Data from a multicentre registry (INBREED), including patients treated with the E-nside endograft, were collected and analysed prospectively. Patients treated for JP-AAA were included. Pre-operative clinical and anatomical characteristics, procedural data, and 30 day and one year outcomes were recorded. Endpoints were technical success, 30 day death, major adverse events (MAEs), and one year freedom from target vessel instability. RESULTS: Of 185 consecutively treated patients, 47 (25.4%) had a JP-AAA (juxtarenal n = 10, 21%; pararenal n = 37, 79%) and were included in the study; 183 target vessels were incorporated through an inner branch. Procedural setting was emergency or urgent in 18 patients (38%) owing to a contained aortic rupture (n = 2, 4%), symptomatic aneurysm (n = 4, 9%), or aneurysm > 70 mm (n = 12, 26%). The mean length of aortic coverage above the coeliac trunk was 116 ± 7 mm. Technical success was 100% and 30 day mortality rate 4% (n = 2 urgent cases). The 30 day cumulative MAE rate was 26% (n = 12): two stroke (4%); and seven spinal cord ischaemia (15%), with six in an elective setting (21%) and one in an urgent setting (6%), and five leading to permanent paraplegia or paraparesis (10%). Freedom from target vessel instability was 99% after 30 days and 97 ± 3% after one year. CONCLUSION: Use of an off the shelf inner branched device for treating JP-AAA was feasible in urgent and elective settings, with high technical success and satisfactory target vessel stability at one year. In the treatment of JP-AAA, stroke and spinal cord ischaemia may be associated with arm access and the increased aortic coverage that the design brings.