TY - JOUR
T1 - Incidence and predictive factors for endograft limb patency of the fenestrated Anaconda endograft used for complex endovascular aneurysm repair
AU - Leeuwerke, Steven J.G.
AU - de Niet, Arne
AU - Geelkerken, Robert H.
AU - Reijnen, Michel M.P.J.
AU - Zeebregts, Clark J.
AU - The Fenestrated Anaconda Study group
N1 - Funding Information:
We extend our special thanks to Dr. M. T. Haalboom, Department of Epidemiology, Medisch Spectrum Twente, for providing assistance with the statistical analyses. The Fenestrated Anaconda Study group included the following: P. Bungay, MA, MB ChB, MRCP, FRCR, and D. Pintar, BS, MSc (Royal Derby Hospital, Derby, United Kingdom); S. Mylonas, PhD, and J. Brunkwall, MD, PhD (University Hospital Cologne, K?ln, Germany); R. D. Moore, MD, and M. Salbalbal, MD (University of Calgary, Calgary, Canada); M. Delbridge, MD (Norfolk and Norwich University Hospitals, United Kingdom); M. M. P. J. Reijnen, MD, PhD, and J. W. Lardenoije, MD, PhD (Rijnstate, Arnhem, The Netherlands); K. Oikonomou, MD, PhD, and P. Kasprzak, MD, PhD (Universit?tsklinikum Regensburg, Regensburg, Germany); R. Meerwaldt, MD, PhD, and R. H. Geelkerken, MD, PhD (Medisch Spectrum Twente, Enschede, The Netherlands); A. Papaioannou, MD, and A. Stehr, MD (Evangelisches Krankenhaus M?lheim, M?lheim an der Ruhr, Germany); C. J. Zeebregts, MD, PhD, I. F. J. Tielliu, MD, PhD, A. de Niet, MD, PhD, and S. J. G. Leeuwerke, MD (University Medical Center Groningen, Groningen, The Netherlands); S. Langer, MD (Marien-Hospital Witten, Witten, Germany); and R. Lakshminarayan, FRCR, EBIR, C. N. Kim, MD, W. P. Ngu, MD, and R. Birk, MD (Hull University Teaching Hospitals NHS Trust, Kingston Upon Hull, UK).
Publisher Copyright:
© 2021 The Authors
PY - 2022/5
Y1 - 2022/5
N2 - Objective: In the present study, we have described the incidence, risk factors, and outcomes of treatment of limb occlusion for patients who had undergone treatment of complex thoracoabdominal aortic aneurysms with the fenestrated Anaconda endograft (Terumo Aortic, Inchinnan, UK).Methods: Between June 2010 and May 2018, 335 patients had undergone elective fenestrated aortic aneurysm repair at 11 participating centers using the fenestrated Anaconda endograft with a median follow-up of 14.3 months (interquartile range, 27.4 months). The primary outcome measure was freedom from limb occlusion. The secondary outcome measures were freedom from limb-related reintervention, secondary patency, and the risk factors associated with limb occlusion.Results: Of the 335 patients, 30 (9.0%) had presented with limb occlusion during follow-up with a freedom from limb occlusion rate of 98.5%, 91.2%, and 81.7% at 30 days and 1 and 5 years, respectively. In 87% of the cases, no obvious cause for limb occlusion was documented. Primary occlusion had occurred within 30 days in 36.7% and within 1 year in 80.0%. Of the 30 patients, 23 (77%) had undergone an occlusion-related reintervention and 7 (23.3%) had been treated conservatively. The freedom from limb occlusion-related reintervention at 30 days and 1 and 5 years was 97.8%, 93.2%, and 88.6%, respectively. Secondary patency was 91.3% after 1 month and 86.2% after 1 and 5 years. Female sex (odds ratio [OR], 3.27; 95% confidence interval [CI], 1.28-8.34; P =.01) was a statistically significant predictor for limb occlusion. A greater proportion of thrombus in the aneurysm sac appeared to be protective for limb occlusion (0% vs <25%: OR, 0.22; 95% CI, 0.07-0.63; P =.01; 0% vs 25%-50%: OR, 0.20; 95% CI, 0.07-0.57; P =.00; and 0% vs >50%: OR, 0.08; 95% CI, 0.02-0.38; P =.00), as did iliac angulation (OR, 0.99; 95% CI, 0.98-1.00; P =.04).Conclusions: Limb occlusion remains a significant impediment of endograft durability for patients treated with the fenestrated Anaconda endograft, especially for female patients. In contrast, a high aneurysmal thrombus load and a high degree of iliac angulation appeared to be protective for limb occlusion, for which no obvious cause could be identified.
AB - Objective: In the present study, we have described the incidence, risk factors, and outcomes of treatment of limb occlusion for patients who had undergone treatment of complex thoracoabdominal aortic aneurysms with the fenestrated Anaconda endograft (Terumo Aortic, Inchinnan, UK).Methods: Between June 2010 and May 2018, 335 patients had undergone elective fenestrated aortic aneurysm repair at 11 participating centers using the fenestrated Anaconda endograft with a median follow-up of 14.3 months (interquartile range, 27.4 months). The primary outcome measure was freedom from limb occlusion. The secondary outcome measures were freedom from limb-related reintervention, secondary patency, and the risk factors associated with limb occlusion.Results: Of the 335 patients, 30 (9.0%) had presented with limb occlusion during follow-up with a freedom from limb occlusion rate of 98.5%, 91.2%, and 81.7% at 30 days and 1 and 5 years, respectively. In 87% of the cases, no obvious cause for limb occlusion was documented. Primary occlusion had occurred within 30 days in 36.7% and within 1 year in 80.0%. Of the 30 patients, 23 (77%) had undergone an occlusion-related reintervention and 7 (23.3%) had been treated conservatively. The freedom from limb occlusion-related reintervention at 30 days and 1 and 5 years was 97.8%, 93.2%, and 88.6%, respectively. Secondary patency was 91.3% after 1 month and 86.2% after 1 and 5 years. Female sex (odds ratio [OR], 3.27; 95% confidence interval [CI], 1.28-8.34; P =.01) was a statistically significant predictor for limb occlusion. A greater proportion of thrombus in the aneurysm sac appeared to be protective for limb occlusion (0% vs <25%: OR, 0.22; 95% CI, 0.07-0.63; P =.01; 0% vs 25%-50%: OR, 0.20; 95% CI, 0.07-0.57; P =.00; and 0% vs >50%: OR, 0.08; 95% CI, 0.02-0.38; P =.00), as did iliac angulation (OR, 0.99; 95% CI, 0.98-1.00; P =.04).Conclusions: Limb occlusion remains a significant impediment of endograft durability for patients treated with the fenestrated Anaconda endograft, especially for female patients. In contrast, a high aneurysmal thrombus load and a high degree of iliac angulation appeared to be protective for limb occlusion, for which no obvious cause could be identified.
KW - Fenestrated endovascular repair
KW - Limb occlusion
KW - Thoracoabdominal aortic aneurysm
KW - UT-Hybrid-D
UR - http://www.scopus.com/inward/record.url?scp=85122433804&partnerID=8YFLogxK
U2 - 10.1016/j.jvs.2021.11.066
DO - 10.1016/j.jvs.2021.11.066
M3 - Article
AN - SCOPUS:85122433804
SN - 0741-5214
VL - 75
SP - 1512-1520.e1
JO - Journal of vascular surgery
JF - Journal of vascular surgery
IS - 5
ER -
