Three Year Data on the Performance of Three Renal Artery Bridging Stent Grafts in Branched Endovascular Repair of Thoraco-Abdominal Pathologies.

Abstract

Previous studies have shown that branched endovascular aneurysm repair (B-EVAR) carries a significant risk of adverse renal events. The purpose of this study was to evaluate the performance of the balloon expandable covered stentgraft (BECS) Advanta/iCast V12, the Viabahn balloon expandable stent (VBX), and the BECS Advanta stent combined with a distally deployed self expanding covered stentgraft (SECS) Viabahn (VSX) as bridging stent grafts (BSGs) in renal arteries. A retrospective analysis of prospectively collected data was conducted at a single centre. Patients undergoing B-EVAR who had at least one Advanta, Advanta + VSX, or VBX as renal artery BSGs were included. Endpoints were patency, endoleaks, target vessel instability (TVI), re-interventions, as well as clinical outcomes including kidney function, new dialysis needs, and death. Data were analysed using Kaplan-Meier estimates and multivariable Cox regression. The study included 255 patients with 431 renal artery BSGs treated by complex aortic repair between 2010 and 2019. Advanta was used predominantly in 2010 - 2014, Advanta + VSX in 2015 - 2017, and VBX in 2018 - 2019. Overall, 125 Advanta, 146 Advanta + VSX, and 160 VBX stents were implanted. The median follow up was 19.3 months. At three years, estimated primary patencies were 82.7 ± 4.6% for renal arteries treated with Advanta, 96.8 ± 1.8% for Advanta + VSX, and 89.0 ± 3.2% for VBX. Estimated freedom from TVI at three years was 82.4 ± 4.7% for renal arteries treated with Advanta, 94.1 ± 2.4% for Advanta + VSX, and 85.4 ± 3.5% for VBX. Freedom from re-intervention estimations at three years were 86.3 ± 3.4% in the Advanta cohort, 95.1 ± 2.0% in the Advanta + VSX cohort, and 91.6 ± 2.4% in the VBX cohort. The combination of BECS and SECS seems to be superior in terms of primary patency compared with BECS alone.