Superior mesenteric artery outcomes after fenestrated endovascular aortic aneurysm repair

Salim Lala, Martyn Knowles, David Timaran, Mirza Shadman Baig, James Valentine, Carlos Timaran

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objective: The Zenith (Cook Medical, Bloomington, Ind) fenestrated endovascular graft may be designed with single-wide scallops or large fenestrations to address the superior mesenteric artery (SMA). Misalignment of the SMA with an unstented scallop or a large fenestration is possible. This study assessed SMA outcomes after fenestrated endovascular aortic aneurysm repair (FEVAR). Methods: During an 18-month period, 47 FEVARs were performed at a single institution. For analysis, patients were grouped according to unstented (n = 23) vs stented (n = 24) SMA scallops/fenestrations. The Institutional Review Board approved this single-institution observational study. Because this was a retrospective review of the data, patient consent was unnecessary for the study. Results: Technical success for FEVAR was 100%. The median follow-up period was 7.7 months (range, 1-16 months). Nine of 21 patients (43%) in the unstented group had some degree of misalignment of the SMA (range, 9%-71%). Among these, four patients (44%) developed complications: three SMA stenoses and one occlusion. The mean peak systolic velocity in patients with and without SMA misalignment was 317.8 cm/s vs 188.4 cm/s (P <.08), respectively. No misalignment occurred in the stented group, and only one of 19 patients (5%) developed an SMA stenosis that required angioplasty. Overall, patients with unstented SMAs had significantly more adverse events directly attributable to SMA misalignment than the stented group (44% vs 5%, respectively; P <.05). Conclusions: Misalignment of the SMA with the use of unstented unreinforced scallops or fenestrations occurs frequently. Routine stenting of single-wide and large fenestrations, when feasible, may be a safer option for patients undergoing FEVAR.

Original languageEnglish (US)
JournalJournal of Vascular Surgery
DOIs
StateAccepted/In press - Dec 10 2015

Fingerprint

Superior Mesenteric Artery
Aortic Aneurysm
Pectinidae
Pathologic Constriction
Research Ethics Committees
Angioplasty
Observational Studies
Transplants

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Superior mesenteric artery outcomes after fenestrated endovascular aortic aneurysm repair. / Lala, Salim; Knowles, Martyn; Timaran, David; Baig, Mirza Shadman; Valentine, James; Timaran, Carlos.

In: Journal of Vascular Surgery, 10.12.2015.

Research output: Contribution to journalArticle

Lala, Salim ; Knowles, Martyn ; Timaran, David ; Baig, Mirza Shadman ; Valentine, James ; Timaran, Carlos. / Superior mesenteric artery outcomes after fenestrated endovascular aortic aneurysm repair. In: Journal of Vascular Surgery. 2015.
@article{0884d112091b42f8bae6cf1c710ece8f,
title = "Superior mesenteric artery outcomes after fenestrated endovascular aortic aneurysm repair",
abstract = "Objective: The Zenith (Cook Medical, Bloomington, Ind) fenestrated endovascular graft may be designed with single-wide scallops or large fenestrations to address the superior mesenteric artery (SMA). Misalignment of the SMA with an unstented scallop or a large fenestration is possible. This study assessed SMA outcomes after fenestrated endovascular aortic aneurysm repair (FEVAR). Methods: During an 18-month period, 47 FEVARs were performed at a single institution. For analysis, patients were grouped according to unstented (n = 23) vs stented (n = 24) SMA scallops/fenestrations. The Institutional Review Board approved this single-institution observational study. Because this was a retrospective review of the data, patient consent was unnecessary for the study. Results: Technical success for FEVAR was 100{\%}. The median follow-up period was 7.7 months (range, 1-16 months). Nine of 21 patients (43{\%}) in the unstented group had some degree of misalignment of the SMA (range, 9{\%}-71{\%}). Among these, four patients (44{\%}) developed complications: three SMA stenoses and one occlusion. The mean peak systolic velocity in patients with and without SMA misalignment was 317.8 cm/s vs 188.4 cm/s (P <.08), respectively. No misalignment occurred in the stented group, and only one of 19 patients (5{\%}) developed an SMA stenosis that required angioplasty. Overall, patients with unstented SMAs had significantly more adverse events directly attributable to SMA misalignment than the stented group (44{\%} vs 5{\%}, respectively; P <.05). Conclusions: Misalignment of the SMA with the use of unstented unreinforced scallops or fenestrations occurs frequently. Routine stenting of single-wide and large fenestrations, when feasible, may be a safer option for patients undergoing FEVAR.",
author = "Salim Lala and Martyn Knowles and David Timaran and Baig, {Mirza Shadman} and James Valentine and Carlos Timaran",
year = "2015",
month = "12",
day = "10",
doi = "10.1016/j.jvs.2016.02.031",
language = "English (US)",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",

}

TY - JOUR

T1 - Superior mesenteric artery outcomes after fenestrated endovascular aortic aneurysm repair

AU - Lala, Salim

AU - Knowles, Martyn

AU - Timaran, David

AU - Baig, Mirza Shadman

AU - Valentine, James

AU - Timaran, Carlos

PY - 2015/12/10

Y1 - 2015/12/10

N2 - Objective: The Zenith (Cook Medical, Bloomington, Ind) fenestrated endovascular graft may be designed with single-wide scallops or large fenestrations to address the superior mesenteric artery (SMA). Misalignment of the SMA with an unstented scallop or a large fenestration is possible. This study assessed SMA outcomes after fenestrated endovascular aortic aneurysm repair (FEVAR). Methods: During an 18-month period, 47 FEVARs were performed at a single institution. For analysis, patients were grouped according to unstented (n = 23) vs stented (n = 24) SMA scallops/fenestrations. The Institutional Review Board approved this single-institution observational study. Because this was a retrospective review of the data, patient consent was unnecessary for the study. Results: Technical success for FEVAR was 100%. The median follow-up period was 7.7 months (range, 1-16 months). Nine of 21 patients (43%) in the unstented group had some degree of misalignment of the SMA (range, 9%-71%). Among these, four patients (44%) developed complications: three SMA stenoses and one occlusion. The mean peak systolic velocity in patients with and without SMA misalignment was 317.8 cm/s vs 188.4 cm/s (P <.08), respectively. No misalignment occurred in the stented group, and only one of 19 patients (5%) developed an SMA stenosis that required angioplasty. Overall, patients with unstented SMAs had significantly more adverse events directly attributable to SMA misalignment than the stented group (44% vs 5%, respectively; P <.05). Conclusions: Misalignment of the SMA with the use of unstented unreinforced scallops or fenestrations occurs frequently. Routine stenting of single-wide and large fenestrations, when feasible, may be a safer option for patients undergoing FEVAR.

AB - Objective: The Zenith (Cook Medical, Bloomington, Ind) fenestrated endovascular graft may be designed with single-wide scallops or large fenestrations to address the superior mesenteric artery (SMA). Misalignment of the SMA with an unstented scallop or a large fenestration is possible. This study assessed SMA outcomes after fenestrated endovascular aortic aneurysm repair (FEVAR). Methods: During an 18-month period, 47 FEVARs were performed at a single institution. For analysis, patients were grouped according to unstented (n = 23) vs stented (n = 24) SMA scallops/fenestrations. The Institutional Review Board approved this single-institution observational study. Because this was a retrospective review of the data, patient consent was unnecessary for the study. Results: Technical success for FEVAR was 100%. The median follow-up period was 7.7 months (range, 1-16 months). Nine of 21 patients (43%) in the unstented group had some degree of misalignment of the SMA (range, 9%-71%). Among these, four patients (44%) developed complications: three SMA stenoses and one occlusion. The mean peak systolic velocity in patients with and without SMA misalignment was 317.8 cm/s vs 188.4 cm/s (P <.08), respectively. No misalignment occurred in the stented group, and only one of 19 patients (5%) developed an SMA stenosis that required angioplasty. Overall, patients with unstented SMAs had significantly more adverse events directly attributable to SMA misalignment than the stented group (44% vs 5%, respectively; P <.05). Conclusions: Misalignment of the SMA with the use of unstented unreinforced scallops or fenestrations occurs frequently. Routine stenting of single-wide and large fenestrations, when feasible, may be a safer option for patients undergoing FEVAR.

UR - http://www.scopus.com/inward/record.url?scp=84973519873&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84973519873&partnerID=8YFLogxK

U2 - 10.1016/j.jvs.2016.02.031

DO - 10.1016/j.jvs.2016.02.031

M3 - Article

C2 - 27288103

AN - SCOPUS:84973519873

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

ER -