P-079 - FIXING BRIDGE TECHNIQUE COMBINING DISTAL COVERED SELF-EXPANDABLE WITH PROXIMAL BALLOON EXPANDABLE STENT-GRAFT IN CASE OF BRANCHED ENDOGRAFTING

TOPIC:
Thoraco-abdominal Aortic Disease
AUTHORS:
Di Stefano L. (Vascular and Endovascular Surgery Unit, Department of Emergency and Organs Transplantation, University of Bari "A. Moro", Bari, Italy ~ Bari ~ Italy) , Palermo D. (Vascular and Endovascular Surgery Unit, Department of Emergency and Organs Transplantation, University of Bari "A. Moro", Bari, Italy ~ Bari ~ Italy) , Pulli R. (Vascular and Endovascular Surgery-University of Florence School of medicine, Florence, Italy ~ Firenze ~ Italy) , Angiletta D. (Vascular and Endovascular Surgery Unit, Department of Emergency and Organs Transplantation, University of Bari "A. Moro", Bari, Italy ~ Bari ~ Italy) , Vacca F.
Introduction:
The aim of the study is to describe early and midterm results of fixing bridge technique- combination of distal covered self-expandable with proximal balloon expandable stent-graft- during branched thoracoabdominal aortic aneurysm (TAAA) repair to limit the incidence of type IIIc endoleak (2% approximatively).
Methods:
Between October 2016 and October 2021, all TAAAs undergoing fenestrated and branched endografting (FB-EVAR) with Cook and Jotec platforms were collected in a dedicated database. Visceral arteries features (length, diameter and orientation) were analyzed on the basis of preoperative CT scan using Aquarius Terarecon softwere. In all cases a self-expandable covered stent-graft (Covera (BD Bard, Tempe AZ) or Viabahn (W. L. Gore & Associates, Inc., Flagstaff, AZ)) was used as bridge stent; in addition, a proximal fixing using a balloon expandable stent-graft (E-ventus BX (Jotec, Hechingen, Germany)) was carried out. In six cases, inferior mesenteric artery was preserved (using parallel graft technique, iliac branch or iliac leg released above the IMA ostium). In nine cases TAAA was associated with obstructive disease of iliac axis and at least one hypogastric artery was preserved using iliac branch (three cases) or parallel graft technique (six cases). Follow-up was performed at 1 and 12 months with CT scan and then annually. Aortic related mortality, bridge stents occlusion, reinterventions and branch instability were evaluated.
Results:
Over a total of 60 TAAAs undergoing FB-EVAR, 215 visceral vessels were targeted. Average follow up was 12 months. In three cases an intraoperative bridge stent occlusion was registered; in two cases occlusion was resolved using Penumbra's Indigo Aspiration System and in one case using AngioJet (Boston Scientific, MA) pheriperal thrombectomy System. At follow-up, aortic related mortality was 0%. Freedom from branch instability and reintervention was 100%.
Conclusion:
In case of complex aortic procedures, the combination of covered self-expandable stent-graft proximally fixed with covered balloon expandable stent-graft seems to be safe and feasible with low rates of occlusion, reintervention and branch instability at early and midterm follow-up. However, long-term follow-up is needed to assess bridge stents patency and instability.