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ludc webb

Nuno Dias

Adjunct professor

ludc webb

Distal landing zone outcomes in thoracic endovascular aortic aneurysm repair with challenging morphology : a propensity-matched comparison of distal active fixation versus standard stent-graft

Author

  • Stefano Gennai
  • Nicola Leone
  • Angelos Karelis
  • Andrea Xodo
  • Luca Mezzetto
  • Aaron Fargion
  • Michele Antonello
  • Gian Franco Veraldi
  • Nuno V Dias
  • Björn Sonesson
  • Carlo Pratesi
  • Roberto Silingardi

Summary, in English

BACKGROUND: To evaluate the distal landing zone (LZ) outcomes in adverse morphology after thoracic endovascular repair (TEVAR) with distal active fixation (DAF) stent-grafts compared with standard endografts.

METHODS: between 2006 and the 31st December 2020, sixty-nine DAFs (study group) and sixty-nine standard stent-grafts (control group) were enrolled in a multi-center, retrospective, case-control study. The primary outcomes were the distal endoleak and reintervention. The secondary outcomes were: distal segment migration, wedge apposition and related complications. A univariate and multivariate logistic regression followed by a propensity-scored model (1:1) were performed.

RESULTS: The results were reported for the DAF vs control group. The mean follow-up was 3.3 ± 2.1 vs 3.7 ± 3.4 years. The distal endoleak rate was 7.3% vs 27.5% (P=0.011). The freedom from distal endoleak was 95%, 95% and 91% vs 85%, 76%, and 73% at 1, 3 and 5 years respectively (Log-rank P=0.011). Tortuosity index and distal thoracic aorta angulation were predictors of endoleak (P=0.012 and P=0.029 respectively). The distal reinterventions rate was 7.3% vs 20.3% (P=0.026). The freedom from distal reinterventions was 95%, 95% and 91% vs 92%, 75% and 75% at 1, 3 and 5 years respectively (Log-rank P=0.041). The wedge apposition was 5.8 vs 13.0-mm (P<0.000). The distal segment migration was upward directed in all cases and was significant (>10- mm) in 13.0% vs 39.1% (P=0.000).

CONCLUSIONS: The DAF stent-graft showed a significant reduction of the distal endoleak rates and other specific outcomes of the distal LZ in patients with an adverse anatomy.

Publishing year

2022

Language

English

Pages

24-32

Publication/Series

International Angiology

Volume

41

Issue

1

Document type

Journal article

Publisher

Minerva Medica

Topic

  • Cardiac and Cardiovascular Systems

Status

Published

ISBN/ISSN/Other

  • ISSN: 1827-1839