Fenestrated Endovascular Aneurysm Repair for Thoracoabdominal Aortic Aneurysms

Early favorable outcomes have been reported with use of the BeGraft bridging stent in fenestrated endovascular aneurysm repair (fEVAR), which have been confirmed during midterm follow-up, with low rates of endoleak and stent occlusion observed. These findings were published in the Journal of Endovascular Therapy.

All consecutive patients treated with fEVAR and the BeGraft Peripheral Stent Graft from November 2015 to September 2016 were enrolled prospectively in a database that was analyzed retrospectively. The indication for repair was maximum aortic diameter of wider than 55 mm or rapid growth, which was defined as wider than 10 mm in 12 months. BeGraft stent grafts were utilized as bridging stents to connect fenestrations to the target vessels, the renal and mesenteric arteries. The BeGraft stent was chosen to treat renal arteries if the diameter of the bridging needed was 6 mm or wider or a length of 22 mm or longer was required. The BeGraft stent was selected to treat mesenteric arteries if the bridging stent diameter required was 7 mm or wider and a length of 38 mm or less was required.

A total of 39 consecutive patients, 38 of whom were men, were enrolled in the study and 101 BeGraft Peripheral Stent Grafts were implanted. Participants were median aged 69.0 years (range, 66.0-74.5 years). The median aneurysm diameter was 60 mm (range, 54.5-67.0 mm). Overall, 29 of the patients had a maximum diameter of wider than 55 mm (median diameter, 64 mm [range, 59-70 mm]), whereas 10 of the participants had a maximum diameter of wider than 50 mm and less than 55 mm with rapid growth (median diameter, 52 mm [range, 51-53 mm]).

The aneurysms were juxtarenal and pararenal in 19 of the patients. There were type 1, 2, and 3 thoracoabdominal aortic aneurysms (TAAAs) in 7 of the participants, type 4 TAAA in 3 of the participants, type 5 TAAA in 4 of the patients, and 6 of the participants experienced a type I endoleak following a prior EVAR.

Of the 101 BeGraft stent grafts that were delivered, 55 were implanted in mesenteric arteries (31 in the superior mesenteric artery, 22 in the coeliac trunk, and 2 in the hepatic or splenic artery), and 46 were implanted into renal arteries (24 in the right renal artery and 22 in the left renal artery). The diameters of the renal arteries were 5 mm, 6 mm, 7 mm, and 8 mm in 9, 7, 26, and 4 of the participants, respectively.

The mesenteric arteries were stented with 7-mm, 8-mm, 9-mm, and 10-mm BeGraft stent grafts. Short-length stents (18 mm) were required in only 2 renal arteries. In contrast, long-length stents (37 mm or 38 mm) were required in 6 target vessels, including 2 renal arteries. All of the other target vessels were stented with 22- to 23-mm or 27- to 28-mm long-length BeGraft stents.

The median study follow-up was 33 months. The follow-up index of the study was 0.85 (range, 0.42 to 0.95). A total of 11 participants died during follow-up, with 6 having died of nonaneurysm-related causes. The cause of death was unknown in 5 patients. There was 1 patient who was lost to follow-up after 13 months. The overall patency rates with bridging stents were 98% and 97% at 1 year and 2 years, respectively, with a freedom from target vessel–related secondary procedure rate on BeGraft stent grafts of 96%.

Limitations of the current study include the fact that additional assessment of the target vessels with respect to preoperative measurement of vessel angulation, stenosis, and calcification warrants consideration, particularly regarding the impact of these factors on the performance and durability of the bridging stents. 

“The data from this study demonstrate the early favorable outcomes of the BeGraft bridging stent used in fEVAR are confirmed during midterm follow-up, with low rates of endoleak and stent occlusion,” the study authors wrote. “Strict and comprehensive imaging surveillance allows early detection of problems and timely re-intervention, preventing potentially major adverse events.”

Disclosure: One of the study authors has declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the author’s disclosures. 

Reference  

Clough RE, Spear R, Mougin J, et al. Midterm outcomes of BeGraft stent grafts used as bridging stents in fenestrated endovascular aortic aneurysm repair. J Endovasc Ther. Published online April 26, 2022. doi:10.1177/15266028221091894