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Geometrical Analysis of Target Vessel Instability After FEVAR With Anaconda Stent-Graft System
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DOI：10.1177/15266028261424752.png)
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Abstract
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Introduction: Fenestrated endovascular aneurysm repair (FEVAR) has emerged as a standard treatment for complex abdominal and thoracoabdominal aortic aneurysms (CAAAs/TAAAs), yet target vessel instability (TVI) remains a concern. This study evaluates mid-term outcomes and anatomical predictors of TVI following FEVAR using the Anaconda custom-made fenestrated stent-graft system (Terumo Aortic, Inchinnan, Scotland, UK).Methods: A retrospective single-center study included all consecutive patients treated with FEVAR using Anaconda stent-graft between September 2013 and December 2023. Preoperative and postoperative vessel geometry was assessed using Aquarius iNtuition software (TeraRecon, Foster City, CA). Primary endpoints were TVI (occlusion, stenosis, type I/III endoleak, or re-intervention) and freedom from re-intervention at 12 months. Secondary endpoints were intraoperative technical success and 30-day major adverse events (MAEs) rate.Results: A total of 101 patients with 359 target vessels were analyzed. Technical success was 97%. The 30-day MAE rate was 21.7%, with no mortality. Target vessel instability occurred in 7.8% (4.5% type IIIc endoleak, 1.4% stenosis, and 1.9% type Ic endoleak) during a median follow-up of 36 months (interquartile range [IQR]=22-55 months). Multivariate analysis identified increased sealing length (odds ratio [OR]=1.080, 95% confidence interval [CI]: 1.002, 1.164, p=0.044) and intra-aortic stent protrusion >= 7 mm (OR=1.406, 95% CI: 1.067, 1.852, p=0.015) as independent predictors of TVI in visceral vessels. In renal target vessels, protrusion >= 7 mm (OR=1.284, 95% CI: 1.019, 1.618, p=0.034) was significantly associated with occlusion. Cumulative incidence of TVI with death as competing risk was 3.1%, 3.6%%, and 5.9% at 1, 2, and 5 years, respectively.Conclusion: Fenestrated endovascular aneurysm repair using the Anaconda stent-graft system demonstrates high technical success and mid-term freedom from TVI. Extended intra-aortic stent protrusion and sealing length, significantly impact TVI adversely. Optimizing bridging stent geometry may reduce re-intervention rates and improve outcomes in complex aortic repairs.
Keywords:
fenestrated endovascular aortic repair
complex abdominal aortic endovascular repair
bridging stent
target vessel instability
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