Endovascular treatment options for complex abdominal aortic aneurysms

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Aortic Aneurysm Treatment

Background:

• Complex aortic aneurysms often necessitate revascularization of visceral arteries.
• Conventional endovascular aneurysm repair (EVAR) may not be suitable for these complex cases.
• Developing alternative EVAR strategies is crucial for managing challenging aortic pathologies.

Purpose of the Study:

• To evaluate the short-term and midterm outcomes of various endovascular aneurysm repair (EVAR) techniques for complex aortic aneurysms.
• To assess the efficacy of revascularizing visceral arteries during EVAR in challenging cases.
• To determine the feasibility of a clinical presentation-based interventional protocol for complex EVAR.

Main Methods:

• Prospective data collection from 34 patients unsuitable for conventional EVAR or surgery.
• Application of custom-made fenestrated EVAR (CM f-EVAR) in elective settings.
• Utilization of homemade fenestrated EVAR (HM f-EVAR) and chimney EVAR (ch-EVAR) in emergent and unstable cases.
• Primary outcome measures included mortality, morbidity, renal function impairment, vessel patency, and survival.

Main Results:

• CM f-EVAR showed a 95.2% visceral vessel patency rate with low complication rates.
• HM f-EVAR and combined HM f-EVAR/ch-EVAR groups had no observed complications.
• ch-EVAR demonstrated a 95% visceral patency rate at 30.9 months, with a 10% rate of transient or permanent renal function impairment.
• No endoleaks were documented across the studied techniques.

Conclusions:

• Endovascular aneurysm repair (EVAR) techniques, including CM f-EVAR, HM f-EVAR, and ch-EVAR, are effective for maintaining visceral artery blood flow during complex aortic aneurysm repair.
• The proposed protocol, tailored to clinical presentation, proved feasible in all treated patients.
• These advanced EVAR methods offer viable solutions for complex aortic aneurysms requiring visceral revascularization.