Effect of aortic angulation on the outcomes of fenestrated-branched endovascular aortic repair

ObjectiveTo investigate the effect of aortic angulation on early and midterm outcomes fenestrated-branched endovascular aneurysm repair for thoracoabdominal aneurysms (TAAA) or pararenal (PRAA).MethodsWe retrospectively reviewed data consecutive patients enrolled in a prospective nonrandomized physician-sponsored investigational device exemption study (2013-2018). The infrarenal, suprarenal, supraceliac angles were measured three-dimensional reconstructions preoperative computed tomography angiogram; 45° cutoff was used analysis. End points technical success, freedom from endograft-related complications (defined by type IA/IB/IIIA/IIIB/IIID endoleaks, limb thrombosis); target vessel instability branch-related death, occlusion, rupture reintervention stenosis, endoleak, disconnection). Cox proportional hazard multivariable regression analyses preformed to assess impact covariates.ResultsThere 298 treated 102 PRAAs (34%) 196 TAAAs (66%) (78 extent IV, 118 I-III) with 1156 renal-mesenteric vessels incorporated. An >45° present infrarenal axis 94 (32%), suprarenal 39 (13%), 93 (31%). A angle more common I-III (P = .01). Technical success 97% not significantly related angulation; total operating time fluoroscopy longer any >45°. Freedom 93% (95% confidence interval [CI], 90%-97%) at 42 months, associated (HR, 1.0; 95% CI, 0.4-2.9; P .976), 1.7; 0.5-1.8; .428), 0.9; 0.3-2.6; .886) Overall 92% 90%-94%) months. By analysis, affected an 1.5; 0.9-2.4; .135) 0.5-1.5; .627), but 5.6; 3.5-9.1; < .001), even after adjustment bridging stent. In this subgroup patients, use directional branch vs fenestration .10) stent did instability.ConclusionsFenestrated-branched can achieve excellent results among >45°, no increase rates graft-related complications. However, increased operative times. most important determinant events, independent design which selected.