P-023 - PARARENAL AORTIC THROMBOUS IN PATIENTS UNDERGOING AORTIC ANEURYSM REPAIR WITH CHIMNEY TECHNIQUE

TOPIC:
Abdominal Aortic Aneurysms
AUTHORS:
Spinelli D. (University of Messina, Dipartimento di Scienze biomediche, odontoiatriche e delle immagini morfologiche e funzionali ~ Messina ~ Italy) , Toro D. (University of Messina, Dipartimento di Scienze biomediche, odontoiatriche e delle immagini morfologiche e funzionali ~ Messina ~ Italy) , La Corte F. (University of Messina, Dipartimento di Scienze biomediche, odontoiatriche e delle immagini morfologiche e funzionali ~ Messina ~ Italy) , Benedetto F. (University of Messina, Dipartimento di Scienze biomediche, odontoiatriche e delle immagini morfologiche e funzionali ~ Messina ~ Italy)
Introduction:
Chimney technique (ChEVAR) can be used to treat patients with pararenal aortic aneurysm unfit for open surgery and not suitable for custom made fenestrated endograft [1]. Since almost one in five patients undergo a reintervention within 3 years, features associated with higher risk of complications need to be investigated in order to tailor the follow-up schedule to each patient [1]. The aim of our study was to assess the impact of mural thrombus in the pararenal aorta on perioperative and follow-up complications after ChEVAR
Methods:
All consecutive patients undergoing ChEVAR at our center from 2015 to 2022 were included in this retrospective study. Collected variables included number of target vessels, stentgraft size, presence and severity of mural thrombus in pararenal aorta, which was reported with a scoring system from 0 to 10 based on thrombus type, thickness area and circumference [2,3]. Analysed outcomes included periopertive and follow-up complications.
Results:
31 patients underwent ChEVAR during the study period. In 4 patients the indication for ChEVAR was type 1A endoleak after a previous EVAR. The number of target vessels was 1 in 17 patients (55%), 2 in 12 (39%), 3 in 1 (3%) and 4 in 1 ( 3%). The mean mural thrombus score was 5.9. Complications were the following: type 1A endoleak in 4 cases (13%), chimney stent complications in 7 cases (23%) (including partial or total thrombosis, intrastent stenosis, displacement), renal function worsening during follow-up in 8 cases (26%). Overall survival was 90% at two years. Patients with severe mural thrombus showed lower freedom from ChEVAR-related complications (28% vs 59% at two years, p=0.023, Figure).
Conclusion:
The presence of severe pararenal aortic mural thrombus was associated with lower freedom from ChEVAR-related complications in patients undergoing ChEVAR for pararenal aortic aneurysm repair. Further research with a larger number of patients is required in order to confirm these results
References:
1) Prapassaro T, Teraa M, Chinsakchai K, Hazenberg CEVB, Hunnangkul S, Moll FL, van Herwaarden JA. Mid-Term Outcomes of Chimney Endovascular Aortic Aneurysm Repair: A Systematic Review and Meta-analysis. Ann Vasc Surg. 2022 Feb;79:359-371. doi: 10.1016/j.avsg.2021.08.013. Epub 2021 Oct 16. PMID: 34666145. 2) Writing Committee Group, Oderich GS, Forbes TL, Chaer R, Davies MG, Lindsay TF, et al. Reporting standards for endovascular aortic repair of aneurysms involving the renal-mesenteric arteries. J Vasc Surg 2021 Jan;73(1S):4S-52S. doi: 10.1016/j.jvs.2020.06.011. Epub 2020 Jun 29. PMID: 32615285. 3)Ribeiro M, Oderich GS, Macedo T, Vrtiska TJ, Hofer J, Chini J, et al. Assessment of aortic wall thrombus predicts outcomes of endovascular repair of complex aortic aneurysms using fenestrated and branched endografts. J Vasc Surg. 2017;66(5):1321-33
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