Exclusion of Healthy Aorta in Complex Aneurysmatic Aortic Pathologies in Endovascular Repair

Endovascular repair (ER) requires to seal within a healthy aorta, resulting in longer exclusion in comparison to open repair. This study aimed to quantify the length and the number of occluded segmental arteries after every ER compared to a hypothetical open repair (HOR) and, secondary, to assess the anatomical factors related to spinal cord ischemia (SCI) in juxtarenal (JAAAs) and pararenal aneurysms (PAAAs).

Patients treated by ER between 2014 and 2023 in our center were included. Using OsiriX®, we reviewed every preoperative and postoperative CTA scans, generating center lumen lines for measurements.

Seventy-seven patients were included (37 JAAA, 6 PAAA and 34 TAA) undergoing 39 fenestrated endovascular aortic repair (FEVAR), 31 branched endovascular aortic repair, and 7 branched/FEVAR. Median length of aortic exclusion in ER is 276.41 ± 112.31 mm compared to HOR 182.07 ± 87.18 mm (P < 0.001, with significance maintained in JAAA, PAAA, and type III TAAA. The number of occluded segmental arteries after ER was significant in the juxtarenal (P < 0.001) and type III TAA compared to HOR. Four cases of transient SCI in the JAAA and PAAA, with significant association identified for aortic exclusion >250 mm and with the chronic or intended internal iliac arteries occlusion.

ER results in significantly longer aortic exclusion and more occluded segmental arteries than HOR, particularly in JAAA and PAAA. It is necessary to perform a comparative study with open repair to better evaluate the potential increased risk of SCI in these subgroups.