Early Experience with the Octopus Endovascular Strategy in the Management of Thoracoabdominal Aneurysms.
Détails
ID Serval
serval:BIB_FB65DEB40A98
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Early Experience with the Octopus Endovascular Strategy in the Management of Thoracoabdominal Aneurysms.
Périodique
Annals of vascular surgery
ISSN
1615-5947 (Electronic)
ISSN-L
0890-5096
Statut éditorial
Publié
Date de publication
11/2019
Peer-reviewed
Oui
Volume
61
Pages
350-355
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: ppublish
Publication Status: ppublish
Résumé
The Octopus endovascular strategy involves placement of multiple, stacked bifurcated grafts in the thoracic segment of a thoracoabdominal aneurysm (TAAA) to facilitate deployment of multiple parallel covered stents for visceral perfusion. This study aimed to review early outcomes of the Octopus TAAA repair strategy at a tertiary, high-volume referral center.
All patients who underwent this Octopus procedure from 2015 to 2018 were reviewed from a prospectively collected single-institution registry. Demographics, comorbidities, and aneurysm anatomy including side and extent, perioperative data including blood loss, length of procedure length of stay, morbidity, and mortality up to 3 years after the procedure were elevated.
A total of 21 patients (48% female, age 72.9 years) underwent the Octopus procedure over the study period. Mean TAAA diameter was 6.7 cm, with 14% dissection related and 86% degenerative TAAA. All patients had been turned down for open repair and 3 (14%) were performed urgently of which 2 were ruptures. TAAA extent was 9% type 2, 62% type 3, and 29% type 4. A mean of 3.04 branches were revascularized per patient, with the superior mesenteric artery (SMA) (90%) perfused through its own limb, and both renals usually reconstructed in parallel graft fashion (left 90%, right 85.7%) with the distal abdominal extension through one of the limbs. Mean operative time was 8 hr, fluoroscopy time 164 min, contrast 182 mL, and blood loss 807 mL. We staged the thoracic and juxtavisceral portions of the cases in 24% of patients. 90% of cases were able to be completed with exclusion of the TAAA and all planned visceral branches cannulated. Perioperative complications included paraplegia (19%) (13.3% permanent, 26.6% temporary), acute kidney injury (24%), prolonged ventilation (19%), myocardial infarction (4.9%), and ischemic bowel (4.8%). Median follow-up was 13.5 months (range 1-26 months). At latest follow-up, type I endoleak rate was 9.5%, with all being treated with proximal cuffs. Other second interventions included restenting of a right renal, angioplasty of an iliac limb kink, and type 2 endoleak coiling. Primary patency of visceral branches was 93.8% at latest follow-up (celiac 100%, SMA 94.7%, right renal 88.9%, left renal 94.8%). In-hospital all-cause mortality rate was 14.2%, with 30-day survival being 90.5%, 6-month survival was 88.3%, one-year survival 71.4%, and 3-year survival was 52.1%.
The Octopus procedure is a high-risk option for urgent or emergent endovascular TAAA repair with off-the-shelf devices in patients who are not candidates for open repair.
All patients who underwent this Octopus procedure from 2015 to 2018 were reviewed from a prospectively collected single-institution registry. Demographics, comorbidities, and aneurysm anatomy including side and extent, perioperative data including blood loss, length of procedure length of stay, morbidity, and mortality up to 3 years after the procedure were elevated.
A total of 21 patients (48% female, age 72.9 years) underwent the Octopus procedure over the study period. Mean TAAA diameter was 6.7 cm, with 14% dissection related and 86% degenerative TAAA. All patients had been turned down for open repair and 3 (14%) were performed urgently of which 2 were ruptures. TAAA extent was 9% type 2, 62% type 3, and 29% type 4. A mean of 3.04 branches were revascularized per patient, with the superior mesenteric artery (SMA) (90%) perfused through its own limb, and both renals usually reconstructed in parallel graft fashion (left 90%, right 85.7%) with the distal abdominal extension through one of the limbs. Mean operative time was 8 hr, fluoroscopy time 164 min, contrast 182 mL, and blood loss 807 mL. We staged the thoracic and juxtavisceral portions of the cases in 24% of patients. 90% of cases were able to be completed with exclusion of the TAAA and all planned visceral branches cannulated. Perioperative complications included paraplegia (19%) (13.3% permanent, 26.6% temporary), acute kidney injury (24%), prolonged ventilation (19%), myocardial infarction (4.9%), and ischemic bowel (4.8%). Median follow-up was 13.5 months (range 1-26 months). At latest follow-up, type I endoleak rate was 9.5%, with all being treated with proximal cuffs. Other second interventions included restenting of a right renal, angioplasty of an iliac limb kink, and type 2 endoleak coiling. Primary patency of visceral branches was 93.8% at latest follow-up (celiac 100%, SMA 94.7%, right renal 88.9%, left renal 94.8%). In-hospital all-cause mortality rate was 14.2%, with 30-day survival being 90.5%, 6-month survival was 88.3%, one-year survival 71.4%, and 3-year survival was 52.1%.
The Octopus procedure is a high-risk option for urgent or emergent endovascular TAAA repair with off-the-shelf devices in patients who are not candidates for open repair.
Mots-clé
Aged, Aged, 80 and over, Aortic Aneurysm, Thoracic/diagnostic imaging, Aortic Aneurysm, Thoracic/mortality, Aortic Aneurysm, Thoracic/physiopathology, Aortic Aneurysm, Thoracic/surgery, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation/adverse effects, Blood Vessel Prosthesis Implantation/instrumentation, Blood Vessel Prosthesis Implantation/mortality, Endovascular Procedures/adverse effects, Endovascular Procedures/instrumentation, Endovascular Procedures/mortality, Female, Hospital Mortality, Hospitals, High-Volume, Humans, Male, Middle Aged, Postoperative Complications/mortality, Postoperative Complications/therapy, Prosthesis Design, Registries, Risk Factors, Tertiary Care Centers, Time Factors, Treatment Outcome, Vascular Patency
Pubmed
Web of science
Création de la notice
09/12/2020 16:48
Dernière modification de la notice
10/12/2020 7:26