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Le Endoprotesi Fenestrate nel trattamento degli j-AAA

Le Endoprotesi Fenestrate nel trattamento degli j-AAA. E.Gallitto , M.Gargiulo, A.Freyrie, C.Mascoli, C.B. Massoni,G. Faggioli, A.Stella. Vascular Surgery Alma Mater Studiorum, Bologna University Policlinico S.Orsola-Malpighi, Bologna, Italy (Chairman: Prof. Andrea Stella).

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Le Endoprotesi Fenestrate nel trattamento degli j-AAA

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  1. Le Endoprotesi Fenestrate nel trattamento degli j-AAA E.Gallitto, M.Gargiulo, A.Freyrie, C.Mascoli, C.B. Massoni,G. Faggioli, A.Stella Vascular Surgery Alma Mater Studiorum, Bologna University Policlinico S.Orsola-Malpighi, Bologna, Italy (Chairman: Prof. Andrea Stella)

  2. Vascular Surgery – University of Bologna Background: jAAA • AAA involving the infra-renal abdominal aorta, that extends up to and sometimes includes the lower margins of renal artery origins • AAA extending to renal arteries without involving them • 2 – 20 % Crawford ES et al Ann Surg 1986 Chaikof EL et al. JVS 2002 Faggioli GL et al. EJVES 1998 Chiesa R et al . JCS 2013

  3. Background: FEVAR Nordon IM et al. EJVES 2009 Vascular Surgery – University of Bologna

  4. Background: FEVAR • Meta – analysis of all published data for FEVAR • Current iusse regards the evidence of potential benefit of • FEVAR for j-AAA? Cross J et al. BJS 2012 Vascular Surgery – University of Bologna

  5. Background: FEVAR ? Cross J et al. BJS 2012 Vascular Surgery – University of Bologna

  6. Background: FEVAR ? Cross J et al. BJS 2012 Vascular Surgery – University of Bologna

  7. Background: FEVAR ? Cross J et al. BJS 2012 Vascular Surgery – University of Bologna

  8. Aim Evaluate early and mid-term results of FEVAR for treating j-AAA Vascular Surgery – University of Bologna

  9. Material & Methods • Prospective, mono-centre • 2008 – 2012 • j-AAAneck lenght < 5 mm • neck angle < 60° • asymptomatic AAA, 50 mm < Ø < 70mm • FEVAR Custom madeCook-Zenith Vascular Surgery – University of Bologna

  10. Endpoints • Early • Techinical (TS) and Clinical Success (CS) • Treated Visceral Vessels Patency (TVVP) • Type I/III endoleaks • Renal function worsening (≥ 30% baseline) Vascular Surgery – University of Bologna

  11. Endpoints • Early • Techinical (TS) and Clinical Success (CS) • Treated Visceral Vessels Patency (TVVP) • Type I/III endoleaks • Renal function worsening (≥ 30% baseline) • Mid-term • Type I/III endoleaks • j-AAA shrinkage (≥ 5 mm) • Freedom from FEVAR-related redo • Survival Vascular Surgery – University of Bologna

  12. Results Vascular Surgery – University of Bologna

  13. FEVAR Endografts (11/20) 55% 2 fenestrations 1 scallop (8/20) 45% 3 fenestrations 1 scallop (1/20) 5% 1fenestrations 1 scallop (5%)1/20 1 fenestration 1 scallop Vascular Surgery – University of Bologna

  14. Target Visceral Vessels • Renal arteries 39 • All fenestrations 6 x 6 mm • SMAs 20 • 8 fenestrations 6x8mm, • 12 scallops • Celiac trunks 8 • All scallops 67 Vascular Surgery – University of Bologna

  15. Visceral Vessels stentgrafts • Renal arteries • 39 Advanta stentgrafts • SMAs • 6 Advanta stentgrafts • 2 Bare stents Vascular Surgery – University of Bologna

  16. Early Endpoints • TS 100% • Endograft deployment • Treated Visceral Vessels Patency • No Type I/III endoleaks • No Conversion • No Mortality Vascular Surgery – University of Bologna

  17. Early Endpoints • CS 95% • 30-day mortality 5%* • 30-day morbidity - • (Cardiac,Pulmonary,Neurological) • Renal Function Worsening 15% • transient 10% • permanent/haemodyalisis 5%* *: it is the same patient Vascular Surgery – University of Bologna

  18. Mid-term Endpoints • Mean f.up 25±20 months (range:2-72) Vascular Surgery – University of Bologna

  19. Mid-term Endpoints • jAAA shrinkage (≤ 5mm) • no FEVAR – related reinterventions Vascular Surgery – University of Bologna

  20. Months 40 10 20 60 80 Mid-term Endpoints • Survival Vascular Surgery – University of Bologna

  21. Literature Review 2001 - 2013 • FEVAR • > 10 cases • Exclusion criteria • Cases duplications • Comparison Study • Previous Aortic Surgery • Home made fenestrated • Off the shelf fenestrated Vascular Surgery – University of Bologna

  22. EARLY REULTS Vascular Surgery – University of Bologna

  23. EARLY REULTS Just 1/3 are really j-AAAs Vascular Surgery – University of Bologna

  24. F.UP REULTS Just 1/3 are really j-AAAs Vascular Surgery – University of Bologna

  25. Conclusion • FEVAR for jAAA effective • Renal functions & TVVP • Long term f.up • First option in high risk patients Vascular Surgery – University of Bologna

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