Impact of intraoperative adverse events during branched and fenestrated aortic stent grafting on postoperative outcome.
OBJECTIVE
Fenestrated and branched endovascular devices are increasingly used for complex aortic diseases, and despite the challenging nature of these procedures, early experiences from pioneering centers have been encouraging. The objectives of this retrospective study were to report our experience of intraoperative adverse events (IOAEs) during fenestrated and branched stent grafting and to analyze the impact on clinical outcomes.


METHODS
Consecutive patients treated with fenestrated and branched stent grafting in a tertiary vascular center between February 2006 and October 2013 were evaluated. A prospectively maintained computerized database was scrutinized and updated retrospectively. Intraoperative angiograms were reviewed to identify IOAEs, and adverse events were categorized into three types: target vessel cannulation, positioning of graft components, and intraoperative access. Clinical consequences of IOAEs were analyzed to ascertain whether they were responsible for death or moderate to severe postoperative complications.


RESULTS
During the study period, 113 consecutive elective patients underwent fenestrated or branched stent grafting. Indications for treatment were asymptomatic complex abdominal aortic aneurysms (CAAAs, n = 89) and thoracoabdominal aortic aneurysms (TAAAs, n = 24). Stent grafts included fenestrated (n = 79) and branched (n = 17) Cook stent grafts (Cook Medical, Bloomington, Ind), Ventana (Endologix, Irvine, Calif) stent grafts (n = 9), and fenestrated Anaconda (Vascutek Terumo, Scotland, UK) stent grafts (n = 8). In-hospital mortality rates for the CAAA and TAAA groups were 6.7% (6 of 89) and 12.5% (3 of 24), respectively. Twenty-eight moderate to severe complications occurred in 21 patients (18.6%). Spinal cord ischemia was recorded in six patients, three of which resolved completely. A total of 37 IOAEs were recorded in 34 (30.1%) patients (22 CAAAs and 12 TAAAs). Of 37 IOAEs, 15 (40.5%) resulted in no clinical consequence in 15 patients; 17 (45.9%) were responsible for moderate to severe complications in 16 patients, and five (13.5%) led to death in four patients. The composite end point death/nonfatal moderate to severe complication occurred more frequently in patients with IOAEs compared with patients without IOAEs (20 of 34 vs 12 of 79; P < .0001).


CONCLUSIONS
In this contemporary series, IOAEs were relatively frequent during branched or fenestrated stenting procedures and were often responsible for significant complications.
Department of Vascular Surgery, Henri Mondor Hospital, Créteil, France. Electronic address: cochennecf@gmail.com.
Frédéric
F
Cochennec
Department of Radiology and Medical Imaging, Henri Mondor Hospital, Créteil, France.
Hicham
H
Kobeiter
Department of Vascular Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
Manj S
MS
Gohel
Department of Vascular Surgery, Henri Mondor Hospital, Créteil, France.
Marek
M
Majewski
Department of Vascular Surgery, Henri Mondor Hospital, Créteil, France.
Jean
J
Marzelle
Department of Vascular Surgery, Henri Mondor Hospital, Créteil, France.
Pascal
P
Desgranges
Department of Vascular Surgery, Henri Mondor Hospital, Créteil, France.
Eric
E
Allaire
Department of Vascular Surgery, Henri Mondor Hospital, Créteil, France.
Jean Pierre
JP
Becquemin
D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic; D001027:Aortography; D001807:Blood Vessel Prosthesis; D057510:Endovascular Procedures; D006801:Humans; D011183:Postoperative Complications; D012086:Reoperation; D015607:Stents; D016896:Treatment Outcome