Complex endovascular repair of paravisceral infective native aortic aneurysms
Juszczak, Maciej Mann, Harvinder Riste, Michael Woodhouse, Andrew Sörelius, Karl Claridge, Martin Adam, Donald J
Juszczak, Maciej
Mann, Harvinder
Riste, Michael
Woodhouse, Andrew
Sörelius, Karl
Claridge, Martin
Adam, Donald J
Citations
Altmetric:
Affiliation
Other Contributors
Publication date
2022-09-04
Subject
Collections
Research Projects
Organizational Units
Journal Issue
Abstract
Objective: To report the early and mid-term outcome of complex endovascular repair (EVAR) for paravisceral infective native aortic aneurysms (INAA).
Methods: Interrogation of a prospectively maintained database identified consecutive patients who underwent non-elective complex EVAR for paravisceral INAAs in a single institution between December 2013 and June 2020. All patients were considered to have definite INAAs based on diagnostic criteria. Patients who had prior aortic repair were excluded.
Results: A total of 26 patients (19 men; mean age 67 years [SD = 11.4]; median diameter 60 mm [IQR: 55-73]) with acute symptomatic (n = 24) or contained ruptured (n = 2) aneurysms underwent surgeon-modified fenestrated EVAR (SM-FEVAR; n = 24) or chimney-periscope EVAR (CHIMPS; n = 2). Median observed follow-up was 36.2 months (18.3-53.5). Nine patients had positive venous blood cultures and a further seven had recent or concomitant infection. All patients received pre- and post-operative antibiotic therapy and rifampicin-soaked endografts. A total of 95 vessels were targeted for preservation and 86 were stent-grafted. One vessel occluded intra-operatively and a further 3 occluded within 30 days. The 30-day/in-hospital mortality was 11.5% (n = 3), and the estimated 1- and 3-year survival (±SD) was 85% ± 7%. Infection-related complications (IRCs) occurred in two patients: both developed new INAA within 30 days of index repair and were treated by EVAR with no mortality. Estimated 3-year freedom from late re-intervention was 100%. One patient required infrarenal EVAR for a non-infective aneurysm at 43 months.
Conclusion: Complex EVAR for paravisceral INAAs is associated with acceptable early and mid-term outcomes and is an acceptable alternative to open surgery. We propose that these patients are managed with long-term antimicrobials, impregnation of graft material with rifampicin, and rigorous post-operative surveillance.
Clinical impact: A multi-disciplinary approach is required to deliver the best possible outcome for patients with this challenging aortic pathology.
Citation
Juszczak M, Mann H, Riste M, Woodhouse A, Sörelius K, Claridge M, Adam DJ. Complex Endovascular Repair of Paravisceral Infective Native Aortic Aneurysms. J Endovasc Ther. 2024 Apr;31(2):223-231. doi: 10.1177/15266028221119333. Epub 2022 Sep 4.
Type
Article