Autor:innen:
PD Dr. med. Athanasios Katsargyris | Universitätsklinik der Paracelsus Medizinischen Privatuniversität Nürnberg | Germany
Vasuki Uthayakumar | Universitätsklinik der Paracelsus Medizinischen Privatuniversität Nürnberg | Germany
Dr. med. Pablo Marques de Marino | Universitätsklinik der Paracelsus Medizinischen Privatuniversität Nürnberg | Germany
Dr. Balazs Botos | Universitätsklinik der Paracelsus Medizinischen Privatuniversität Nürnberg | Germany
Dr. med. Sebastian Nagel | Universitätsklinik der Paracelsus Medizinischen Privatuniversität Nürnberg | Germany
Prof. Dr. med. Eric Verhoeven | Universitätsklinik der Paracelsus Medizinischen Privatuniversität Nürnberg | Germany
Objective: Treatment of complex aortic pathologies with customized fenestrated/branched stent-grafts (F/BEVAR) is associated with a waiting time before the procedure. This is the result of the time required for decision of the treatment plan, design of the graft-plan, graft construction and delivery. This study aimed to investigate mortality and other complications that occurred during the waiting time for a fenestrated/branched stent-graft in our institution.
Materials and Methods: All patients with a complex abdominal or thoracoabdominal aortic aneurysm planned to be treated with a customized fenestrated/branched stent-graft in our institution within the period January 2010 –December 2018 were included. Patients in which the procedure was aborted due to mortality or other reasons during the waiting time were identified and analysed.
Results: A total of 906 patients were planned to undergo F/BEVAR during the study period. Of those, 862 (95.1%) patients underwent the procedure as planned (FEVAR for pararenal AAA; n=494, F/BEVAR for TAAA; n=348, F/BEVAR for Arch aneurysm; n=20). In 44 (4.9%) cases, the procedure was aborted. Reasons for the abort were: mortality before the procedure in 37 (4.1%) patients and other reasons in 7 (0.8%) patients [patient denied the operation, n=4 (0.4%); poor general condition, n=2 (0.2%); patient with rupture that underwent emergency open repair in another institution, n=1 (0.1%)]. Causes of mortality during the waiting time before the procedure were: aneurysm rupture, n=15 (1.7%); cardiac, n=7 (0.8%); stroke, n=3 (0.3%); gastrointestinal, n=3 (0.3%); surgical mortality after complete proximal debranching by cardiac surgery, n=2 (0.2%); infection, n=2 (0.2%); mortality after TAVI, n=1 (0.1%); mortality after urological surgery, n=1 (0.1%); unknown, n=3 (0.3%).
Aneurysm diameter was bigger in patients that died of aneurysm rupture compared to patients that died of other reasons (79.2 ± 13mm vs 66.7 ± 12mm respectively, P=.005). The mean time interval between the date of 1st contact and date of death for all patients that died (n=37) was 8.3 ± 7.7 weeks, and for patients who died due to aneurysm rupture (n=15) 5.4 ± 4.3 weeks.
Conclusions: Aneurysm rupture during waiting time for F/BEVAR can occur, but is rare. Potential measures to reduce the risk of rupture during waiting time might include the use of off-the shelf devices for larger aneurysms, quicker measurement and graft plan order processes, and quicker graft construction and delivery.