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Retrograde Target Vessel Catheterization as a Salvage Procedure in Fenestrated/Branched Endografting
Kyriakos Oikonomou1, Athanasios Katsargyris1, Clayton J Brinster1
1Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany.
Insights
Retrograde target vessel access is a viable bailout for fenestrated and branched endovascular aortic repair (F/B-EVAR) when standard methods fail. While technically successful in most cases, it carries increased risks and longer hospital stays.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Aortic Aneurysm Repair
Background:
- Fenestrated and branched endovascular aortic repair (F/B-EVAR) offers minimally invasive treatment for complex aortic aneurysms.
- Antegrade access for target vessel cannulation can occasionally fail, necessitating alternative strategies.
Purpose of the Study:
- To evaluate the feasibility and outcomes of retrograde target vessel catheterization as a bailout technique in F/B-EVAR.
- To assess the technical success, perioperative complications, and long-term results of this approach.
Main Methods:
- A retrospective review of 671 F/B-EVAR cases between 2003 and 2014.
- Identified 11 patients (1.6%) requiring retrograde target vessel access due to failed antegrade attempts.
- Detailed analysis of access success, complications, and follow-up data.
Main Results:
- Successful retrograde catheterization and stent-grafting in 10 out of 11 patients.
- One early death (9.1%) and major perioperative complications in 6 patients (renal function deterioration, wound dehiscence, pneumonia).
- Median hospital stay of 20 days; mean follow-up of 26 months with one late unrelated death.
Conclusions:
- Retrograde target vessel access is a feasible bailout strategy for F/B-EVAR when antegrade cannulation fails.
- The procedure demonstrates high secondary technical success but is associated with increased perioperative morbidity and prolonged hospitalization.
Purpose:
To present retrograde target vessel catheterization as a bailout technique in fenestrated and branched endografting (F/B-EVAR).
Methods:
Between November 2003 and November 2014, 11 (1.6%) of 671 consecutive patients with juxtarenal, suprarenal, and thoracoabdominal aortic aneurysms required retrograde target vessel access as a bailout measure during F/B-EVAR due to failure of an antegrade approach. The target vessels involved the left renal artery (LRA) in 6 patients, the celiac artery (CA) in 3 patients, the right renal artery (RRA) in 1 patient, and both renal arteries in 1 patient.
Results:
The target vessels were successfully catheterized and secured with stent-grafts in 10 patients; a single case was unsuccessful because the fenestration was in the wrong position and blocked against the arterial wall. One (9.1%) patient died within 30 days. Major perioperative complications occurred in 6 patients, including 3 with renal function deterioration, 2 with access-site wound dehiscence, and a case of pneumonia. Median hospital stay was 20 days (range 7-60) and median intensive care unit stay was 2.5 days (range 0-9). Over a mean 26-month follow-up (range 1-60), one unrelated death occurred. Reintervention was required in 1 patient due to progression of an aneurysm of the right iliac artery.
Conclusion:
Retrograde target vessel access in F/B-EVAR is a feasible bailout procedure when antegrade cannulation fails. Secondary technical success is high, but the procedure is associated with higher perioperative morbidity and longer hospital stay.