title: Management of complicated aortic aneurysms using multiple overlapping uncovered stents: mid-term outcome from a cohort study.
abstract: This study sought to report the mid-term outcome of a modified flow-diverting strategy in the treatment of complicated aortic aneurysms of different morphology. Historical data suggested aortic aneurysm expansion and rupture after endovascular treatment with current commercial flow-diverters, indicating the essentiality of further investigation of this technique prior to its large-scale clinical application. An alternative flow-diverting strategy using layer-by-layer assembled multiple overlapping uncovered stents was employed in this study. The treatment outcome in aneurysms of different morphology (saccular, fusiform, and dissecting) was assessed during a mid-term follow-up period.Of 42 patients enrolled in this study (30 male, mean age: 63.3 years), technical success was achieved in 40 cases. During an average follow-up period of 20.9 months, mean aneurysm diameter shrunk from 53.4 ± 13.6 mm to 48.8 ± 13.9 mm (P < 0.001), while stent-induced sac thrombosis ratio increased significantly (18.1 ± 14.9% to 93.6 ± 9.5%, P < 0.001). The majority of side branches (74/76 major visceral branches, 237/244 minor segmental arteries), covered by 3.3 stents on average, maintained their patency after stenting. Saccular aneurysms manifested the highest thrombus deposition speed (18/20 were totally thrombosed within 12 months) and most significant shrinkage (51.4 ± 13.3 mm pre-operatively vs 43.5 ± 10.2 mm during follow-up, P < 0.001) compared with fusiform and dissecting aneurysms. This modified flow-diverting strategy could be a feasible alternative in the management of complicated aortic aneurysms where vital branches need to be preserved. The treatment outcome may depend on the aneurysm type. Further studies with larger patient cohort and longer follow-up are required to substantiate these results.
authors.affiliation: From the Division of Vascular Surgery, Changhai Hospital, Shanghai, China (YZ, QL, ZZ, JB, XF, RF); University Department of Radiology, University of Cambridge, UK (YZ, ZT, YH, JHG); Department of Engineering, University of Cambridge, UK (ZT); School of Aerospace, Tsinghua University, Beijing, China (ZC); Cambridge Vascular Unit, Addenbrooke's Hospital, Cambridge, UK (US); and Military Institute of Vascular Disease, the First Affiliated Hospital of Second Military Medical University, Shanghai, China (ZJ).
authors.forename: Yongxue
authors.initials: Y
authors.lastname: Zhang
authors.forename: Zhongzhao
authors.initials: Z
authors.lastname: Teng
authors.forename: Qingsheng
authors.initials: Q
authors.lastname: Lu
authors.forename: Zhiqing
authors.initials: Z
authors.lastname: Zhao
authors.forename: Junmin
authors.initials: J
authors.lastname: Bao
authors.forename: Xiang
authors.initials: X
authors.lastname: Feng
authors.forename: Rui
authors.initials: R
authors.lastname: Feng
authors.forename: Zengsheng
authors.initials: Z
authors.lastname: Chen
authors.forename: Yuan
authors.initials: Y
authors.lastname: Huang
authors.forename: Umar
authors.initials: U
authors.lastname: Sadat
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Gillard
authors.forename: Zaiping
authors.initials: Z
authors.lastname: Jing
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000473:pathology / Q000601:surgery*; D001011:Aorta / Q000473:pathology*; D001014:Aortic Aneurysm / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D057510:Endovascular Procedures / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents