Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.200230
Jornal Vascular Brasileiro
Original Article

Unibody design for aortic disease with a narrow aortic bifurcation: tips and tricks for success

Design unimodular para doença da aorta com bifurcação aórtica estreita: dicas para o sucesso

Ricardo de Alvarenga Yoshida; Renato Fanchiotti Costa; Débora Ortigosa Cunha; Rafael Mendes Palhares; Rodrigo Gibin Jaldin; Marcone Lima Sobreira; Rafael Elias Farres Pimenta; Winston Bonetti Yoshida

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Abstract

Abstract: Background: Surgical management of patients with abdominal aortic diseases associated with distal narrowing is a challenging situation.

Objectives: To evaluate outcomes of unibody bifurcated endovascular stent graft repair.

Methods: This is a retrospective, observational, multi-institutional database study of a cohort of consecutive cases, approved by the local Ethics Committee. Records were reviewed of patients diagnosed from 2010 to 2020 with “shaggy” aorta, saccular aneurysm, penetrating aortic ulcer, and isolated aortic dissection located in the infrarenal abdominal aorta. All patients were treated with a unibody bifurcated stent graft. Main outcomes were technical success, procedure complications, long-term patency, and mortality in the follow-up period up to 5 years. Data on demographics, comorbidities, surgical management, and outcomes were analyzed.

Results: Twenty-three patients were treated with unibody bifurcated stent graft repair, including 7 cases of “shaggy” aorta, 3 isolated dissections of the abdominal aorta, 4 penetrating aortic ulcers, and 9 saccular aneurysms. Immediate technical success was achieved in 100% of cases. At follow-up, all stent grafts remained patent and there were no limb occlusions. The patients were symptom-free and reported no complications related to the procedure. There were 5 deaths during the follow-up period (median= 4 years), but none were related to the procedure and there were no aorta-related deaths.

Conclusions: The present study shows that unibody bifurcated stent grafting is safe and effective in this group of patients with narrow distal abdominal aorta and complex aortic pathology. The results were similar for both infrarenal aortic aneurysms and aorto-iliac atherosclerotic disease.

Keywords

abdominal aorta, aortic diseases, saccular aneurysm, aneurysm, endovascular procedures

Resumo

Resumo: Contexto: O manejo cirúrgico de pacientes com doenças da aorta abdominal associadas ao estreitamento distal é desafiador.

Objetivos: Avaliar os desfechos do reparo endovascular com endoprótese bifurcada do tipo monobloco.

Métodos: Foi realizado um estudo retrospectivo, de coorte observacional, de banco de dados multi-institucional, com casos consecutivos, após aprovação pelo Comitê de Ética local. Foram analisados prontuários de pacientes com diagnóstico de shaggy aorta, aneurisma sacular, úlcera penetrante da aorta e dissecção isolada da aorta localizados na aorta abdominal infrarrenal entre 2010 e 2020; todos os pacientes foram tratados com endoprótese bifurcada do tipo monobloco. Os principais desfechos foram sucesso técnico, complicações relacionadas ao procedimento, perviedade de longo prazo e mortalidade no seguimento de até 5 anos. Foram incluídos dados demográficos, comorbidades, manejo cirúrgico e desfechos.

Resultados: Vinte e três pacientes foram tratados com endoprótese bifurcada do tipo monobloco, incluindo 7 casos de shaggy aorta, 3 dissecções isoladas da aorta abdominal, 4 úlceras penetrantes da aorta e 9 aneurismas saculares. Sucesso técnico imediato foi obtido em 100% dos casos. No seguimento, todas as endopróteses permaneceram pérvias e não houve oclusões de membros. Os pacientes estavam sem sintomas e não relataram complicações relacionadas ao procedimento. Ocorreram 5 óbitos durante o seguimento (mediana = 4 anos), mas nenhum relacionado ao procedimento ou à aorta.

Conclusões: O presente estudo mostra que a endoprótese bifurcada do tipo monobloco é segura e eficaz neste grupo de pacientes com estreitamento distal da aorta abdominal e patologia aórtica complexa. Os resultados foram semelhantes para aneurismas da aorta infrarrenal e doença aterosclerótica aortoilíaca.
 

Palavras-chave

aorta abdominal, doenças da aorta, aneurisma sacular, aneurisma, procedimentos endovasculares

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Submitted date:
03/23/2021

Accepted date:
05/28/2021

61642ad1a953957f795dd8b3 jvb Articles
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