UTILIZZO DI AFX (ENDOLOGIX) STENTGRAFT IN PAZIENTI CON PATOLOGIA AORTO-ILIACA TASC-D E ANEURISMA DELL AORTA ADDOMINALE
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1 IN PAZIENTI CON PATOLOGIA AORTO-ILIACA TASC-D E ANEURISMA DELL AORTA ADDOMINALE C.F. Porreca, P. Sirignano, W. Mansour, M. Formiconi, M. Brunoro, L. Capoccia, F. Speziale Vascular and Endovascular Surgery Division Department of Surgery Paride Stefanini - Policlinico Umberto I Sapienza University of Rome Chief Prof F Speziale
2 TASC II, J Vasc Surg, 2007
3 TASC II, J Vasc Surg, 2007
4 Despite TASC II several Authors have proposed an endovascular approach for TASC D lesions. Consequently, endovascular techniques are becoming a first-line therapy due to the potential to provide a less invasive treatment associated with reduced morbidity and mortality Sharafuddin MJ et al. AVS 2008 de Donato G, et al al AVS 2015 Maldonado TS, et al. EJVS 2016 Dijkstra ML, et al. JEVT 2017
5 The most widely investigated procedure for this indication, kissing stents demonstrates good results, despite technical challenges and increasing procedure complexity.
6 Moreover, kissing stent patency may be compromised due to radial size mismatch between the stents and the distal aorta
7 The Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) technique was developed to overcome the anatomical and physiological disadvantages of kissing stents.
8
9 91 AIOD lesions (74 TASC D) 100% technical success 9 reintervention during follow-up Patients with concomitant AAA >3.5cm were excluded Maldonado TS, et al. EJVS 2016
10 AIM To evaluate role of the AFX stent-graft implantation in patients with TASC-D AIOD and coexistent Abdominal Aortic Aneurysms
11 STUDY POPULATION January 2013 December TASC D+AAA / 93 AIOD Rutherford Category 2 4pts 3 14pts 4 3pts
12 STUDY POPULATION 21 Patients Age 73.6±6.4 (57-89) Male Sex 17; 80.9% Hypertension 18; 85.7% Dyslipidaemia 14; 66.7% Diabetes 13; 61.9% CAD 9; 42.8% Smoke 16; 76.2% COPD 9; 42.9% CRI 7; 33.3% ASA III/IV 8; 38.1%
13 STUDY POPULATION AAA diameter 36.2±3.8mm Bifurcation diameter 13±2.3mm CIA EIA SFA 4 occlusion, 1 bilateral 14 sever stenosis 2 occlusion, no bilateral 18 severe stenosis 6 occlusions, 1 bilateral
14 Stenoses Dilatation AFX Implantation Occlusion controlateral recanalization (intraluminal whenever possible) dilatation AFX Implantation No brachial/axillary access No re-entry devices METHODS
15 METHODS Outcome measures: clinical* and technical success 30-day and midterm patency *Clinical success was defined as improvement in ABI 2 or more Rutherford Cathegories
16 RESULTS 100% technical and clinical success Intraluminal recanalization in 2 CIA occlusions (1 retrograde) 5 patients required suprarenal fixation No CIA stenting 18 EIAs required stenting
17 30-day follow-up RESULTS No high-flow endoleaks All AFX devices patent All patients improvement >2 Rutherford category
18 Mean follow-up RESULTS 25.2±11.1months (range 5 40) All treated vessels were patent Rutherford categories were 0 3pts 1 17pts 2 1pts
19 CONCLUSION Our data seem to support the use of the AFX stent-graft in this subgroup of patients with TASC D AIOD and AAA, with satisfactory midterm results and acceptable risk for patients.
20 Thank you Symposium Chairman Francesco Speziale Scientific Secretariat Laura Capoccia Wassim Mansour Pasqualino Sirignano Vascular and Endovascular Surgery Division Department of Surgery Paride Stefanini Sapienza University of Rome Policlinico Umberto I caput.meeting@gmail.com
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