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Updated: Aug 29, 2025
04:56
Modified Octopus Technique for Thoracoabdominal Aortic Aneurysm
Published on: August 1, 2025
84
Complex Endovascular Repair of Paravisceral Infective Native Aortic Aneurysms
Maciej Juszczak1,2, Harvinder Mann1, Michael Riste3
1Department of Vascular Surgery, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Summary
Complex endovascular repair (EVAR) for paravisceral infective native aortic aneurysms (INAA) shows promising early and mid-term results. This approach offers an alternative to open surgery, with careful management and surveillance being key.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Medical Devices
Background:
- Infective native aortic aneurysms (INAA) are a rare but serious condition.
- Paravisceral INAA present unique challenges for treatment.
- Traditional open repair carries significant risks.
Purpose of the Study:
- To evaluate the early and mid-term outcomes of complex endovascular repair (EVAR) for paravisceral INAA.
- To assess the safety and efficacy of EVAR in this patient population.
- To compare EVAR outcomes with historical open repair data.
Main Methods:
- A prospectively maintained database was queried for patients undergoing non-elective complex EVAR for paravisceral INAA.
- Patients with definite INAA and no prior aortic repair were included.
- Surgeon-modified fenestrated EVAR (SM-FEVAR) and chimney-periscope EVAR (CHIMPS) were utilized, with antibiotic therapy and rifampicin-soaked endografts.
Main Results:
- 26 patients underwent complex EVAR (24 SM-FEVAR, 2 CHIMPS) for paravisceral INAA.
- Median follow-up was 36.2 months.
- 30-day/in-hospital mortality was 11.5%. Estimated 1- and 3-year survival was 85% ± 7%.
- Infection-related complications occurred in 2 patients, successfully treated with EVAR.
- Estimated 3-year freedom from late re-intervention was 100%.
Conclusions:
- Complex EVAR is a viable alternative to open surgery for paravisceral INAA.
- Long-term antimicrobials, rifampicin-impregnated grafts, and rigorous surveillance are recommended.
- A multidisciplinary approach is crucial for managing this challenging pathology.
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