Midterm Outcomes of BeGraft Stent Grafts Used as Bridging Stents in Fenestrated Endovascular Aortic Aneurysm Repair

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Abstract

Purpose:

Fenestrated endovascular aneurysm repair (fEVAR) is established for the treatment of juxtarenal, pararenal, and thoracoabdominal aortic aneurysms (TAAAs). Bridging stents are used to connect the main body of the stent graft to the aortic branch vessels. Complications related to the bridging stents compromise the durability of the repair and require urgent re-intervention. Here we present the midterm results of the BeGraft stent graft system used for fEVAR.

Materials and method:

All consecutive patients treated with fEVAR and the current BeGraft Peripheral Stent Graft between November 2015 and September 2016 were included.

Results:

Thirty-nine consecutive patients (38 men) were enrolled and 101 BeGraft second-generation stent grafts were implanted. The median aneurysm diameter was 60 mm (54.5–67.0 mm). Aneurysms were juxtarenal and pararenal (19/39, 48.1%), type 4 TAAA (3/39, 7.7%), type 1, 2, and 3 TAAA (7/39, 17.8%), type 5 TAAA (4/39, 10.2%), and 15.4% (6/39) had a type I endoleak following a previous EVAR. Fifty-five BeGrafts were implanted in mesenteric arteries (22 in coeliac trunks, 31 in the superior mesenteric artery, and 2 in a hepatic or splenic artery) and 46 into renal arteries (24 right and 22 left). The renal artery diameters were 5, 6, 7, and 8 mm in 9, 7, 26, and 4 patients, respectively. Mesenteric arteries were exclusively stented with 9 and 10 mm diameter devices. The median follow-up was 33 months (IQ25 17–IQ75 36). During follow-up, 11 patients died (28%) from non–aneurysm-related causes. The overall patency rates for bridging stents were 98% and 97% at 1 and 2 years, respectively, with a freedom from secondary procedure rate on BeGraft stent grafts of 96% (97/101). All events occurred on stents implanted in renal arteries.

Conclusion:

Early favorable outcomes are confirmed during longer term follow-up. Vigilant surveillance is required.

Related collections

Most cited references 17

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Is Open Access

Completeness of Follow-Up Determines Validity of Study Findings: Results of a Prospective Repeated Measures Cohort Study

Regula von Allmen, Salome Weiss, Hendrik Tevaearai Stahel … (2015)

Background Current reporting guidelines do not call for standardised declaration of follow-up completeness, although study validity depends on the representativeness of measured outcomes. The Follow-Up Index (FUI) describes follow-up completeness at a given study end date as ratio between the investigated and the potential follow-up period. The association between FUI and the accuracy of survival-estimates was investigated. Methods FUI and Kaplan-Meier estimates were calculated twice for 1207 consecutive patients undergoing aortic repair during an 11-year period: in a scenario A the population’s clinical routine follow-up data (available from a prospective registry) was analysed conventionally. For the control scenario B, an independent survey was completed at the predefined study end. To determine the relation between FUI and the accuracy of study findings, discrepancies between scenarios regarding FUI, follow-up duration and cumulative survival-estimates were evaluated using multivariate analyses. Results Scenario A noted 89 deaths (7.4%) during a mean considered follow-up of 30±28months. Scenario B, although analysing the same study period, detected 304 deaths (25.2%, P<0.001) as it scrutinized the complete follow-up period (49±32months). FUI (0.57±0.35 versus 1.00±0, P<0.001) and cumulative survival estimates (78.7% versus 50.7%, P<0.001) differed significantly between scenarios, suggesting that incomplete follow-up information led to underestimation of mortality. Degree of follow-up completeness (i.e. FUI-quartiles and FUI-intervals) correlated directly with accuracy of study findings: underestimation of long-term mortality increased almost linearly by 30% with every 0.1 drop in FUI (adjusted HR 1.30; 95%-CI 1.24;1.36, P<0.001). Conclusion Follow-up completeness is a pre-requisite for reliable outcome assessment and should be declared systematically. FUI represents a simple measure suited as reporting standard. Evidence lacking such information must be challenged as potentially flawed by selection bias.

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Reporting standards for endovascular aortic repair of aneurysms involving the renal-mesenteric arteries

Gustavo S Oderich, Thomas Forbes, Rabih Chaer … (2021)

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Fenestrated and branched endovascular aneurysm repair outcomes for type II and III thoracoabdominal aortic aneurysms.

Matthew J Eagleton, Matthew Follansbee, Katherine Wolski … (2016)

Thoracoabdominal aortic aneurysm (TAAA) repair remains a challenging clinical pathology. Endovascular technology, in particular the evolution of fenestrated and branched (F/B) endografts used in endovascular aneurysm repair (EVAR) has provided a less invasive method of treating these complex aneurysms. This study evaluated the technical and clinical outcomes of F/B-EVAR for extensive type II and III TAAA.

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Author and article information

Journal

Journal ID (nlm-ta): J Endovasc Ther

Journal ID (iso-abbrev): J Endovasc Ther

Journal ID (publisher-id): JET

Journal ID (hwp): spjet

Title: Journal of Endovascular Therapy

Publisher: SAGE Publications (Sage CA: Los Angeles, CA )

ISSN (Print): 1526-6028

ISSN (Electronic): 1545-1550

Publication date (Electronic): 26 April 2022

Publication date (Print): August 2023

Volume: 30

Issue: 4

Pages: 592-599

Affiliations

[1 ]School of Biomedical Engineering and Imaging Science, St Thomas’ Hospital, King’s College London, London, UK

[2 ]Vascular Surgery, CHU Grenoble, Grenoble, France

[3 ]Aortic Centre, Groupe Hospitalier Paris Saint Joseph, Hôpital Marie Lannelongue, INSERM UMR_S 999, Université Paris-Saclay, Gif-sur-Yvette, France

[4 ]Vascular Surgery, CHRU Lille, Lille, France

Author notes

[*]Stéphan Haulon, Aortic Centre, Groupe Hospitalier Paris Saint Joseph, Hôpital Marie Lannelongue, INSERM UMR_S 999, Université Paris-Saclay, Gif-sur-Yvette, 92350, France. Email: s.haulon@ 123456ghpsj.fr

[*]

Stephan is a consultant for GE, Bentley and Cook Medical.

Author information

Rachel E. Clough https://orcid.org/0000-0002-4243-6836

Dominique Fabre https://orcid.org/0000-0001-7340-9550

Article

Publisher ID: 10.1177_15266028221091894

DOI: 10.1177/15266028221091894

PMC ID: 10350705

PubMed ID: 35471131

SO-VID: 41be2438-f1f2-4283-80f5-0999458edc90

License:

This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

History

Custom metadata

typesetter ts1

Keywords: bridging stent,begraft,bentley,fenestrated,aneurysm,aorta

Data availability:

Keywords: bridging stent, begraft, bentley, fenestrated, aneurysm, aorta