O-125 - PRELIMINARY RESULTS OF A NOVEL ULTRA-LOW PROFILE ENDOGRAFT FOR THE ENDOVASCULAR REPAIR OF INFRARENAL ABDOMINAL AORTIC ANEURYSMS

TOPIC:
Abdominal Aortic Aneurysms
AUTHORS:
Squizzato F. (University of Padova ~ Padova ~ Italy) , Grego F. (University of Padova ~ Padova ~ Italy) , Gibello L. (University of Torino ~ Torino ~ Italy) , Robaldo A. (IIMSI - Istituto Imaging della Svizzera Italiana ~ Lugano ~ Switzerland) , Rinaldi L. (Policlinico di Monza ~ Monza ~ Italy) , Trillini M. (San Bassiano Hospital ~ Bassano ~ Italy) , Porcellato L. (San Bassiano Hospital ~ Bassano ~ Italy) , Ruffino M.A. (IIMSI - Istituto Imaging della Svizzera Italiana ~ Lugano ~ Switzerland) , Vigliotti G. (Ospedale del Mare ~ Napoli ~ Italy) , Trevisan A. (Cardinal Massaia Hospital ~ Asti ~ Italy) , Marone E.M. (Policlinico di Monza ~ Monza ~ Italy) , Cognolato D. (San Bassiano Hospital ~ Bassano ~ Italy) , Verzini F. (University of Torino ~ Torino ~ Italy) , Piazza M. (University of Padova ~ Padova ~ Italy) , Antonello M. (University of Padova ~ Padova ~ Italy)
Introduction:
The Minos endograft (MicroPort/Lombard Medical, Oxfordshire, UK) is a novel ultra-low profile device for the treatment of infrarenal abdominal aortic aneurysm, that received the CE mark in 2020; however, the real-world clinical outcomes of this device are still underreported. The aim of the study was to investigate the early and midterm outcomes of the Minos device using a physician-initiated multicenter registry.
Methods:
We collected the data from a non-sponsored physician-initiated multicenter registry, including consecutive patients treated with the Minos endograft in 7 european centers (January 2021- March 2022). The device consists in a tri-modular endograft with supra-renal fixation and a ultra-low profile (main body: 14-16 F; iliac limb: 12F). All data were stored in a dedicated electronic data capture system. Preoperative clinical and anatomical data, procedural data, and early (30-days) outcomes were recorded. Patients with standard anatomy (standard EVAR, sEVAR) were compared with those with complex anatomy (complex EVAR, cEVAR). Anatomical complexity was classified as related to the proximal neck (length <10mm, non-cilindrical neck shape, angulation >60°) or the iliac axis (tortuosity index >1.6, iliac diameter <7mm, or aortic bifurcation diameter <16 mm). The primary endpoint was 30-days technical success, defined as the successful introduction and deployment of the device in the absence of surgical conversion or mortality, type I or type III endoleak, or graft limb obstruction. Follow-up was based on computed tomography angiogram CTA at 1, 6 and 12 months. Follow-up results were reported in terms of freedom from aneurysm rupture, type I or type III endoleak, graft limb obstruction, or endograft-related reintervention.
Results:
There were 40 patients treated for infrarenal AAA (mean diameter, 54±9 mm) in an elective (n=39, 98%) or urgent (n=1, 2%) setting. Twenty-two patients (55%) had a complex anatomy related to the proximal neck (n=9, 23%), iliac characteristics (n=16, 40%), or both (n=3, 8%). Overall, general anesthesia was adopted in 30 patients (75%) and a bilateral percutaneous access was used in 34 (85%) cases. Thirty-days technical success was 97.5% and there were no related deaths. Comparing sEVAR with cEVAR, operative time (99±32 vs 124±68; P=.157), contrast volume (90±15 ml vs 100±18 ml; P=.272) and radiation exposure (890± 234 mGy*cm2 vs 1092±412 mGy*cm2; P=.483) were similar. Four patients in the cEVAR group (18%) received adjunctive iliac limb reinforcement with a bare metal stent (P=.114) during the index intervention, and one patient (2.5%) received an early endovascular reintervention due to limb compression detected at the first post-operative CTA. Six-months follow-up was available for 10 patients. There were no aneurism-related deaths, type I or III endoleaks. There was 1 reintervention of iliac limb relining 2 months after EVAR in a patient in the cEVAR group.
Conclusion:
In this real-life multicenter registry, the use of a novel ultra-low profile endograft was feasible and safe, and was adopted for the treatment of AAAs with a complex anatomy in half of cases. The device showed promising results also in patients with anatomical complexities related to the proximal neck or iliac arteries; patients with a complex iliac anatomy may more often require adjunctive limb reinforcement during EVAR, in order to prevent limb compression or occlusion. A larger number of patients with longer follow-up is still needed.