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The role of selective stenting for superior mesenteric artery scallops during fenestrated endovascular aneurysm repair.

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Citation: Journal of Vascular Surgery. 69(1):47-52, 2019 01.PMID: 29960791Institution: MedStar Heart & Vascular Institute, BaltimoreForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Aortic Aneurysm, Abdominal/su [Surgery] | *Blood Vessel Prosthesis | *Blood Vessel Prosthesis Implantation/is [Instrumentation] | *Endovascular Procedures/is [Instrumentation] | *Mesenteric Artery, Superior/su [Surgery] | *Stents | Aged | Aged, 80 and over | Aortic Aneurysm, Abdominal/dg [Diagnostic Imaging] | Aortic Aneurysm, Abdominal/mo [Mortality] | Aortic Aneurysm, Abdominal/pp [Physiopathology] | Blood Vessel Prosthesis Implantation/ae [Adverse Effects] | Blood Vessel Prosthesis Implantation/mo [Mortality] | Endovascular Procedures/ae [Adverse Effects] | Endovascular Procedures/mo [Mortality] | Female | Humans | Male | Mesenteric Artery, Superior/dg [Diagnostic Imaging] | Mesenteric Artery, Superior/pp [Physiopathology] | North Carolina | Prosthesis Design | Registries | Retrospective Studies | Risk Factors | Time Factors | Treatment Outcome | Vascular PatencyYear: 2019 Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:

0741-5214

Name of journal: Journal of vascular surgeryAbstract: CONCLUSIONS: Single-wide SMA scallops of ZFEN during FEVAR procedures may be selectively stented using specific criteria and rigorous follow-up, without compromising the safety and efficacy of the SMA.Copyright Published by Elsevier Inc.METHODS: This study is a single-institution retrospective review of prospectively enrolled patients treated at the University of North Carolina at Chapel Hill between July 2010 and August 2014. Only patients with SMA scallops were included for analysis. We compared results between patients grouped as stented or unstented SMA scallops. The scallops were stented when one or more of the following criteria were present: misalignment of scallop determined by balloon testing intraoperatively; configuration consisting of an SMA scallop and a single renal fenestration or stent; and pre-existing stenosis in the vessel adjacent to the graft scallop. The study was approved by the local Institutional Review Board. Primary outcomes addressed were mortality, vessel patency, early and late complications, and reintervention rates. Baseline characteristics of the patients and procedure data were also described.OBJECTIVE: Stenting of small fenestrations of the Zenith fenestrated endograft (ZFEN; Cook Medical, Bloomington, Ind) is necessary during fenestrated endovascular aneurysm repair (FEVAR) of complex abdominal aortic aneurysms to avoid malalignment. However, stenting of superior mesenteric artery (SMA) scallops of ZFEN devices is optional according to the instructions for use. The objective of this study was to assess the early and midterm outcomes of selective use of stents in SMA scallops of ZFEN during FEVAR procedures.RESULTS: During the 48-month study period, 61 patients were treated for complex abdominal aortic aneurysms at the University of North Carolina with a mean age of 73 years, and 74.3% of patients were male. Thirty-nine of 61 patients (63.9%) had a device design with an SMA scallop and were included for analysis. Eleven of 39 patients (28%) had the SMA primarily stented and 28 (72%) were unstented. There was only one death (2.5%) during the 30-day postoperative period, with 100% technical success and branch patency. In the unstented group, there were three SMA complications during follow-up, two requiring reintervention; however, there were no associated deaths. Among the stented group, there was one branch-related complication that occurred during the procedure but no stent stenosis or occlusion during the long-term follow-up. During the mean follow-up period of 21.7 months, no SMA stent thrombosis occurred. There was no statistical difference in outcomes between groups.All authors: Farber MA, Kalbaugh CA, Motta F, Vallabhaneni RFiscal year: FY2018Digital Object Identifier:

https://dx.doi.org/10.1016/j.jvs.2018.05.016

Date added to catalog: 2018-07-30

Holdings ( 1 )
Title notes ( 7 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	29960791	Available		29960791

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

CONCLUSIONS: Single-wide SMA scallops of ZFEN during FEVAR procedures may be selectively stented using specific criteria and rigorous follow-up, without compromising the safety and efficacy of the SMA.

METHODS: This study is a single-institution retrospective review of prospectively enrolled patients treated at the University of North Carolina at Chapel Hill between July 2010 and August 2014. Only patients with SMA scallops were included for analysis. We compared results between patients grouped as stented or unstented SMA scallops. The scallops were stented when one or more of the following criteria were present: misalignment of scallop determined by balloon testing intraoperatively; configuration consisting of an SMA scallop and a single renal fenestration or stent; and pre-existing stenosis in the vessel adjacent to the graft scallop. The study was approved by the local Institutional Review Board. Primary outcomes addressed were mortality, vessel patency, early and late complications, and reintervention rates. Baseline characteristics of the patients and procedure data were also described.

OBJECTIVE: Stenting of small fenestrations of the Zenith fenestrated endograft (ZFEN; Cook Medical, Bloomington, Ind) is necessary during fenestrated endovascular aneurysm repair (FEVAR) of complex abdominal aortic aneurysms to avoid malalignment. However, stenting of superior mesenteric artery (SMA) scallops of ZFEN devices is optional according to the instructions for use. The objective of this study was to assess the early and midterm outcomes of selective use of stents in SMA scallops of ZFEN during FEVAR procedures.

RESULTS: During the 48-month study period, 61 patients were treated for complex abdominal aortic aneurysms at the University of North Carolina with a mean age of 73 years, and 74.3% of patients were male. Thirty-nine of 61 patients (63.9%) had a device design with an SMA scallop and were included for analysis. Eleven of 39 patients (28%) had the SMA primarily stented and 28 (72%) were unstented. There was only one death (2.5%) during the 30-day postoperative period, with 100% technical success and branch patency. In the unstented group, there were three SMA complications during follow-up, two requiring reintervention; however, there were no associated deaths. Among the stented group, there was one branch-related complication that occurred during the procedure but no stent stenosis or occlusion during the long-term follow-up. During the mean follow-up period of 21.7 months, no SMA stent thrombosis occurred. There was no statistical difference in outcomes between groups.

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