O-148 - RISK FACTORS FOR TYPE III ENDOLEAKS FROM DIRECTIONAL BRANCHES AFTER BRANCHED ENDOVASCULAR ANEURYSM REPAIR FOR THORACO-ABDOMINAL AORTIC ANEURYSMS.

TOPIC:
Thoraco-abdominal Aortic Disease
AUTHORS:
Migliari M. (Azienda Ospedaliero-Universitaria di Modena ~ Modena ~ Italy) , Gennai S. (Azienda Ospedaliero-Universitaria di Modena ~ Modena ~ Italy) , Simonte G. (Santa Maria della Misericordia Hospital ~ Perugia ~ Italy) , Isernia G. (Santa Maria della Misericordia Hospital ~ Perugia ~ Italy) , Leone N. (Azienda Ospedaliero-Universitaria di Modena ~ Modena ~ Italy) , Fino G. (Santa Maria della Misericordia Hospital ~ Perugia ~ Italy) , Farchioni L. (Azienda Ospedaliero-Universitaria di Modena ~ Modena ~ Italy) , Lenti M. (Santa Maria della Misericordia Hospital ~ Perugia ~ Italy) , Silingardi R. (Azienda Ospedaliero-Universitaria di Modena ~ Modena ~ Italy)
Introduction:
Mid-term durability of branches has already been established, and BF-EVAR had become the treatment of choice for thoraco-abdominal aortic aneurysms. Nevertheless, target vessel instability remains the most frequent adverse event after complex endovascular aortic repair. Type III endoleaks from directional branches have been reported with a low incidence, but risk factors for this complication have not been investigated yet.
Methods:
This was a dual-center observational retrospective cohort study. Data of each patient treated with BEVAR between April 2008 and December 2019 were prospectively collected. The primary outcome was to assess potential risk factors for branch disconnection and fracture. A logistic regression analysis was performed, including preoperative and postoperative measurements as well as intraoperative details. A Cox regression hazard analysis was performed to evaluate the influence of preoperative TAAA diameter and TVV angulation on the outcome.
Results:
Two-hundred-ninety-five target visceral vessels in 91 patients were considered suitable for cannulation. Technical success was 96.9% (286/295 target visceral vessels). The median follow-up was 32.5 months (IQR 14.2-50.1 months). A total of 12 type III endoleaks from directional branches were detected (5 BSG fractures and 7 BSG disconnections). Five type III endoleaks involved the celiac trunk (1 BSG fracture and 4 BSG disconnections), five the superior mesenteric artery (4 BSG fractures and one disconnection), and two the renal arteries (both BSG disconnections). The median time to type III endoleak was 22.2 months (IQR 10.9-37.6 months). Preoperative TAAA diameter (P .028), preoperative TVV angulation (P .037), the use of a BeGraft stent-graft as BSG (P< .001), and different stent types on the same vessel (P .048) were associated with type III endoleak at univariable analysis. The use of a BeGraft stent-graft (P .001) was the only significant factor predisposing to type III endoleak at multiple logistic regression. Cox regression hazard analysis showed a two-fold increased risk for type III endoleak every 10mm increase in preoperative TAAA diameter (HR 2.00; 95%CI 1.08-3.72; P .028) and a 1.5 increased risk every 12° increase of preoperative TVV angulation (HR 1.47; 95%CI 1.02-2.10; P .037).
Conclusion:
Type III endoleaks from directional branches are a rare but severe complication after BEVAR. Preoperative aneurysm diameter and TVV angulation are significantly associated with an increased risk of postoperative type III endoleak. The use of BeGraft stent-grafts as BSG may increase the risk of modular disconnection and BSG fracture. Correction of type III endoleak is mandatory and is usually a safe and effective procedure. A strict CTA follow-up is necessary to detect target vessel instability.