Preloaded Catheters and Guide-Wire Systems to Facilitate Catheterization During Fenestrated and Branched Endovascular Aortic Repair

Julia Chini, Bernardo C. Mendes, Emanuel R. Tenorio, Mauricio S. Ribeiro, Giuliano A. Sandri, Stephen Cha, Jan Hofer, Gustavo Oderich

Research output: Contribution to journalArticle

Abstract

Objective: The aim of this study was to review the clinical outcomes for patients treated for pararenal (PRA) and thoracoabdominal aortic aneurysms (TAAAs) by fenestrated–branched endovascular aortic repair (F-BEVAR) using preloaded systems (PLS). Methods: We reviewed clinical data of 83 patients (64 male, mean age 75 ± 7 years) enrolled in a prospective study to investigate F-BEVAR. All patients had PLS, which included two catheters or two through-and-through guide wires with 12-Fr trans-brachial sheaths positioned in the descending thoracic aorta. Outcome measurements were technical success defined as successful deployment of the main fenestrated stent graft and cannulation of all target vessels, total endovascular time, total lower extremity ischemia time and complications, 30-day mortality, and major adverse events (MAEs). Results: Aneurysm extent was PRA in 27 patients and TAAA in 56 (35 extent IV and 21 extent I–III). A total of 333 target vessels were incorporated with an average of 4 ± 0.4 vessels per patient. Technical success was 99.7%. Total endovascular time was 160 ± 51 min. Sixty-five (78%) patients had motor and somatosensory evoked potentials monitoring, and lower extremity ischemia time was 115 ± 42 min. There were no 30-day mortalities. Fifteen patients (18%) had MAEs, including three (3.6%) minor ischemic strokes. There were no upper extremity complications. All ischemic strokes occurred in female patients (3.6% vs. 0%, P =.001). One (1.2%) patient had paraplegia. Conclusion: This study shows high technical success and early lower limb reperfusion using PLS with trans-brachial access. The risk of stroke, especially in female patients, should be carefully assessed by review of preoperative arch imaging.

Original languageEnglish (US)
JournalCardioVascular and Interventional Radiology
DOIs
StateAccepted/In press - Jan 1 2019

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Catheterization
Catheters
Thoracic Aortic Aneurysm
Lower Extremity
Stroke
Thoracic Aorta
Arm
Ischemia
Motor Evoked Potentials
Somatosensory Evoked Potentials
Mortality
Paraplegia
Upper Extremity
Reperfusion
Stents
Aneurysm
Prospective Studies
Transplants

Keywords

  • Complex aortic aneurysm
  • Fenestrated and branched endovascular repair
  • Preloaded catheter
  • Thoracoabdominal aortic aneurysm

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Preloaded Catheters and Guide-Wire Systems to Facilitate Catheterization During Fenestrated and Branched Endovascular Aortic Repair. / Chini, Julia; Mendes, Bernardo C.; Tenorio, Emanuel R.; Ribeiro, Mauricio S.; Sandri, Giuliano A.; Cha, Stephen; Hofer, Jan; Oderich, Gustavo.

In: CardioVascular and Interventional Radiology, 01.01.2019.

Research output: Contribution to journalArticle

Chini, Julia ; Mendes, Bernardo C. ; Tenorio, Emanuel R. ; Ribeiro, Mauricio S. ; Sandri, Giuliano A. ; Cha, Stephen ; Hofer, Jan ; Oderich, Gustavo. / Preloaded Catheters and Guide-Wire Systems to Facilitate Catheterization During Fenestrated and Branched Endovascular Aortic Repair. In: CardioVascular and Interventional Radiology. 2019.
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abstract = "Objective: The aim of this study was to review the clinical outcomes for patients treated for pararenal (PRA) and thoracoabdominal aortic aneurysms (TAAAs) by fenestrated–branched endovascular aortic repair (F-BEVAR) using preloaded systems (PLS). Methods: We reviewed clinical data of 83 patients (64 male, mean age 75 ± 7 years) enrolled in a prospective study to investigate F-BEVAR. All patients had PLS, which included two catheters or two through-and-through guide wires with 12-Fr trans-brachial sheaths positioned in the descending thoracic aorta. Outcome measurements were technical success defined as successful deployment of the main fenestrated stent graft and cannulation of all target vessels, total endovascular time, total lower extremity ischemia time and complications, 30-day mortality, and major adverse events (MAEs). Results: Aneurysm extent was PRA in 27 patients and TAAA in 56 (35 extent IV and 21 extent I–III). A total of 333 target vessels were incorporated with an average of 4 ± 0.4 vessels per patient. Technical success was 99.7{\%}. Total endovascular time was 160 ± 51 min. Sixty-five (78{\%}) patients had motor and somatosensory evoked potentials monitoring, and lower extremity ischemia time was 115 ± 42 min. There were no 30-day mortalities. Fifteen patients (18{\%}) had MAEs, including three (3.6{\%}) minor ischemic strokes. There were no upper extremity complications. All ischemic strokes occurred in female patients (3.6{\%} vs. 0{\%}, P =.001). One (1.2{\%}) patient had paraplegia. Conclusion: This study shows high technical success and early lower limb reperfusion using PLS with trans-brachial access. The risk of stroke, especially in female patients, should be carefully assessed by review of preoperative arch imaging.",
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T1 - Preloaded Catheters and Guide-Wire Systems to Facilitate Catheterization During Fenestrated and Branched Endovascular Aortic Repair

AU - Chini, Julia

AU - Mendes, Bernardo C.

AU - Tenorio, Emanuel R.

AU - Ribeiro, Mauricio S.

AU - Sandri, Giuliano A.

AU - Cha, Stephen

AU - Hofer, Jan

AU - Oderich, Gustavo

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: The aim of this study was to review the clinical outcomes for patients treated for pararenal (PRA) and thoracoabdominal aortic aneurysms (TAAAs) by fenestrated–branched endovascular aortic repair (F-BEVAR) using preloaded systems (PLS). Methods: We reviewed clinical data of 83 patients (64 male, mean age 75 ± 7 years) enrolled in a prospective study to investigate F-BEVAR. All patients had PLS, which included two catheters or two through-and-through guide wires with 12-Fr trans-brachial sheaths positioned in the descending thoracic aorta. Outcome measurements were technical success defined as successful deployment of the main fenestrated stent graft and cannulation of all target vessels, total endovascular time, total lower extremity ischemia time and complications, 30-day mortality, and major adverse events (MAEs). Results: Aneurysm extent was PRA in 27 patients and TAAA in 56 (35 extent IV and 21 extent I–III). A total of 333 target vessels were incorporated with an average of 4 ± 0.4 vessels per patient. Technical success was 99.7%. Total endovascular time was 160 ± 51 min. Sixty-five (78%) patients had motor and somatosensory evoked potentials monitoring, and lower extremity ischemia time was 115 ± 42 min. There were no 30-day mortalities. Fifteen patients (18%) had MAEs, including three (3.6%) minor ischemic strokes. There were no upper extremity complications. All ischemic strokes occurred in female patients (3.6% vs. 0%, P =.001). One (1.2%) patient had paraplegia. Conclusion: This study shows high technical success and early lower limb reperfusion using PLS with trans-brachial access. The risk of stroke, especially in female patients, should be carefully assessed by review of preoperative arch imaging.

AB - Objective: The aim of this study was to review the clinical outcomes for patients treated for pararenal (PRA) and thoracoabdominal aortic aneurysms (TAAAs) by fenestrated–branched endovascular aortic repair (F-BEVAR) using preloaded systems (PLS). Methods: We reviewed clinical data of 83 patients (64 male, mean age 75 ± 7 years) enrolled in a prospective study to investigate F-BEVAR. All patients had PLS, which included two catheters or two through-and-through guide wires with 12-Fr trans-brachial sheaths positioned in the descending thoracic aorta. Outcome measurements were technical success defined as successful deployment of the main fenestrated stent graft and cannulation of all target vessels, total endovascular time, total lower extremity ischemia time and complications, 30-day mortality, and major adverse events (MAEs). Results: Aneurysm extent was PRA in 27 patients and TAAA in 56 (35 extent IV and 21 extent I–III). A total of 333 target vessels were incorporated with an average of 4 ± 0.4 vessels per patient. Technical success was 99.7%. Total endovascular time was 160 ± 51 min. Sixty-five (78%) patients had motor and somatosensory evoked potentials monitoring, and lower extremity ischemia time was 115 ± 42 min. There were no 30-day mortalities. Fifteen patients (18%) had MAEs, including three (3.6%) minor ischemic strokes. There were no upper extremity complications. All ischemic strokes occurred in female patients (3.6% vs. 0%, P =.001). One (1.2%) patient had paraplegia. Conclusion: This study shows high technical success and early lower limb reperfusion using PLS with trans-brachial access. The risk of stroke, especially in female patients, should be carefully assessed by review of preoperative arch imaging.

KW - Complex aortic aneurysm

KW - Fenestrated and branched endovascular repair

KW - Preloaded catheter

KW - Thoracoabdominal aortic aneurysm

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