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Increased complexity of FEVARequals
increased complications
M. Austermann
Department of Vascular Surgery
St. Franziskus Hospital Münster
Head: Univ.- Prof. Dr. G. Torsello
PD Dr. med. Martin AustermannSenior consultant andLeader of section „endovascular aortic therapy“
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Disclosure
• Speaker name:
• ...........Priv.-Doz. Dr. Martin Austermann
......................................................................
• I have the following potential conflicts of interest to report:
• X Consulting /Proctorship Cook and Gore
• Employment in industry
• Stockholder of a healthcare company
• Owner of a healthcare company
• Other(s)
• I do not have any potential conflict of interest
Increased complexity of FEVAR equals increased complications
PD Dr. med. Martin AustermannSenior consultant andLeader of section „endovascular aortic therapy“
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23.05.2019 Martin Austermann 3
Zenith ® Fenestrated AAA Endovascular Graft:
scallop
Höhe 6 – 12 mmBreite 10 mmOption double wide
small fenestration
Höhe 6-8 mmBreite 6 mm
Increased complexity of FEVAR equals increased complications
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Increased complexity of FEVAR equals increased complications
FEVAR with scallop re NA ,small fenestration li NA
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Increased complexity of FEVAR equals increased complications
Complex FEVAR with 4 fenestrations
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Fenestrations:Not forgiving!
Crucial:Exact sizing, planningand implantation.
Meticulous patient selection.
Increased complexity of FEVAR equals increased complications
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BSG-Dislocation 2 Y after FEVAR
Therapy: Relining with 8x38 V12
Increased complexity of FEVAR equals increased complications
Therapy: Relining with 6x26 Begraft +
Crushing RRA BSG 6 month after FEVAR
Therapy:PTA and BSG-Extension with SECS
Type 1 c Endoleak6 month after FEVAR
Complications of FEVAR
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CT-Stenosis 1year after FEVAR
Increased complexity of FEVAR equals increased complications
Therapy:Extension BSG with BECS and SES
Dislocation RRA BSG
Therapy: Relining with BECS
Complications of FEVAR
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Increased complexity of FEVAR equals increased complications
N=173, mean age=76, 90% male
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Increased complexity of FEVAR equals increased complications
30d mortality: 5,2% (9 pt)
3 visceral ischemia (4 and 3 fens)2 myocardial infarction2 MOF1 retroperitoneal bleeding1 aspiration and pneumonia
30d mortality 1 and 2 fens: 2% 2/83 pt30d mortality 3 and 4 fens: 8% 7/90 ptP=0,059
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Increased complexity of FEVAR equals increased complications
Median FU 34 monthsIQR 16 – 50 months
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Increased complexity of FEVAR equals increased complications
N=318 pt from 14 centers
Perioperative mortality: 4,1%
Group 1 (renal fenestrations) 2,7% 2/73Group 2 (renal fens and scallop SMA) 2,9% 5/168Group 3 (incorporation of the CT) 9,4% 6/64
P=0,098 n.s.
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Increased complexity of FEVAR equals increased complications
Survival TV PatencyFreedom fromreintervention
N=384
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Increased complexity of FEVAR equals increased complications
So….
If we put all this together: FEVAR works
But the more complex the graft and theprocedure becomes, you have more chancesto fail or to have troubles.
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Increased complexity of FEVAR equals increased complications
My way to go:
If I have to go for a sealingabove the celiac trunc, I like to use branches .
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Branches: Pro Forgiving!
Chance:Standardization
T-BranchTM
Fa. COOK
Need:Space for thebranches(25mm lumen)
Münsterapplicability
63%Bisdas et al. J Endovasc Ther 2013;20:672-77
Increased complexity of FEVAR equals increased complications
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Increased complexity of FEVAR equals increased complications
0%
10%
20%
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40%
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90%
100%
FEVAR and BEVAR in Münster
1-2 Fens 3-4 Fens Branched
0
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FEVAR and BEVAR in Münster
1-2 Fens 3-4 Fens Branched
Evolution of stentgraft configurations in Münster
N= 536 : 1-2 Fens: 95 3-4 Fens: 141 Branched: 300
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male, 61 Y, AFB , single left renal artery, 6 cm TAAA type 4
Increased complexity of FEVAR equals increased complications
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BEVAR needs flexible bridging stentgrafts
Increased complexity of FEVAR equals increased complications
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Bridging the target vessels
Increased complexity of FEVAR equals increased complications
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Summary:
Fenestrations - not forgiving- suitable anatomie is needed- The more fenestrations you have themore complications can occure.
Branches - more forgiving- enough space is needed for the branches.- more coverage of the thoracic aorta (SCI)
Flexibel bridging stentgrafts are needed to achieveoptimal long term results for BEVAR!
Increased complexity of FEVAR equals increased complications
Balance is the key.
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St. Franziskus Hospital Münster
Thank you for your attention !
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e-mail: [email protected]
Increased complexity of FEVAR equals increased complications