72230 - Cone-beam computed tomography during fenestrated aortic repair avoids a significant number of structural defects that would demand reintervention

Introduction

Structural defects during fenestrated endovascular aortic repair (FEVAR) can be difficult to identify intraoperatively. This study aims to assess the potential value of routine intraoperative completion cone-beam computed tomography (CBCT) during FEVAR.

Method

A retrospective review of all consecutive FEVARs in a 10-year period was performed in our aortic center. Patients with intraoperative plain CBCT and postoperative CTA were selected. Endpoints included intraoperative adjunctive procedures (IAP) and early secondary reinterventions due to structural defects. These were analyzed by type, frequency and indication (CBCT, first postoperative CTA or symptoms). Data is presented as mean±SD or Median (IQR).

Result

Some 233 out of 269 patients treated with FEVAR (4(3-4) fenestrations) were included (195 male, 72±6 years old, 218 (92%) elective repairs).

In 39 patients (17%), 44 IAP were needed due to structural defect based on CBCT with renal bridging stent compression being the most common (n=21, 49%). All structural defects treated intraoperatively are listed in Table I.

Secondary reintervention was performed in 11 patients (5%) for 14 structural defects with renal stent compression being once more the most common indication(n=8). All these defects went unnoticed during the intraoperative review of the CBCT. Two out of the 11 missed defects had clinical implications that were successfully corrected:1 renal stent occlusion and 1claudication due to iliac limb stenosis.

No reinterventions were needed on the patients with an intraoperative CBCT-motivated adjunctive procedure.

Discussion

The use of an intraoperative plain CBCT allows the identification of a significant number of structural defects that can be corrected immediately, avoiding reinterventions.