Anatomic Feasibility of a Specifically Designed Custom Made Device as Off the Shelf Endograft for Urgent Repair of Complex Abdominal Aortic Aneurysm.

Abstract

To evaluate the theoretical anatomic feasibility of a specifically designed custom made device with one fenestration for the superior mesenteric artery, two inner branches for the renals, and an incorporated distal bifurcated device (Cook Medical, Brisbane, Australia), to be developed as an off the shelf endograft for endovascular repair of urgent complex abdominal aortic aneurysm (cAAA). This was a retrospective single centre study. Pre-operative computed tomography angiograms (CTAs) of consecutive patients treated for cAAA by open or endovascular repair were reviewed. CTAs were collected and analysed retrospectively. Theoretical feasibility was determined based on pre-determined anatomic inclusion and exclusion criteria for access, aortic (proximal and paravisceral diameter), and target vessel characteristics. A description of the technical feasibility in an urgent real world clinical case is also provided, where the coeliac trunk was bridged through an additional physician modified reinforced fenestration. A total of 250 CTAs were evaluated, including 92 juxtarenal abdominal aortic aneurysms (JRAAs), 84 pararenal abdominal aortic aneurysms (PRAAs), and 74 extent IV thoraco-abdominal aneurysms (type IV). Overall feasibility was 60.8% (69% in JRAA, 65% in PRAA, and 53% in type IV). Access feasibility was 90.2% and aortic feasibility was 67.2%; target vessel feasibility was 73.2% and when stratified by subgroup it was 77% in type IV, 82% in PRAA, and 79% in JRAA (p = .73). Type IV had lower overall feasibility compared with PRAA and JRAA (p = .030), which was mainly related to a lower aortic feasibility owing to a paravisceral aortic diameter > 40 mm (7%) or diameter of the proximal landing zone > 34 mm (6%). This newly proposed, specifically designed custom made device demonstrated broad versatility for different anatomies improving the theoretical applicability in an extensive cohort of cAAA. Clinical application needs to be developed to evaluate safety and efficacy.