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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 experienc...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Society for Vascular Surgery. Published by Elsevier Inc.
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7127795/ https://www.ncbi.nlm.nih.gov/pubmed/24767710 http://dx.doi.org/10.1016/j.jvs.2014.02.065 |
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author | Cochennec, Frédéric Kobeiter, Hicham Gohel, Manj S. Majewski, Marek Marzelle, Jean Desgranges, Pascal Allaire, Eric Becquemin, Jean Pierre |
author_facet | Cochennec, Frédéric Kobeiter, Hicham Gohel, Manj S. Majewski, Marek Marzelle, Jean Desgranges, Pascal Allaire, Eric Becquemin, Jean Pierre |
author_sort | Cochennec, Frédéric |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-7127795 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Society for Vascular Surgery. Published by Elsevier Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-71277952020-04-08 Impact of intraoperative adverse events during branched and fenestrated aortic stent grafting on postoperative outcome Cochennec, Frédéric Kobeiter, Hicham Gohel, Manj S. Majewski, Marek Marzelle, Jean Desgranges, Pascal Allaire, Eric Becquemin, Jean Pierre J Vasc Surg Article 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. Society for Vascular Surgery. Published by Elsevier Inc. 2014-09 2014-04-21 /pmc/articles/PMC7127795/ /pubmed/24767710 http://dx.doi.org/10.1016/j.jvs.2014.02.065 Text en Copyright © 2014 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
spellingShingle | Article Cochennec, Frédéric Kobeiter, Hicham Gohel, Manj S. Majewski, Marek Marzelle, Jean Desgranges, Pascal Allaire, Eric Becquemin, Jean Pierre Impact of intraoperative adverse events during branched and fenestrated aortic stent grafting on postoperative outcome |
title | Impact of intraoperative adverse events during branched and fenestrated aortic stent grafting on postoperative outcome |
title_full | Impact of intraoperative adverse events during branched and fenestrated aortic stent grafting on postoperative outcome |
title_fullStr | Impact of intraoperative adverse events during branched and fenestrated aortic stent grafting on postoperative outcome |
title_full_unstemmed | Impact of intraoperative adverse events during branched and fenestrated aortic stent grafting on postoperative outcome |
title_short | Impact of intraoperative adverse events during branched and fenestrated aortic stent grafting on postoperative outcome |
title_sort | impact of intraoperative adverse events during branched and fenestrated aortic stent grafting on postoperative outcome |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7127795/ https://www.ncbi.nlm.nih.gov/pubmed/24767710 http://dx.doi.org/10.1016/j.jvs.2014.02.065 |
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