Clinical Research For Endovascular Treatment Of Aortic Pathologies Involving Visceral Arteries

Objective: The aim was to explore the optimal technique between f-EVAR and ch-EVAR to reconstruct visceral arteries for aortic pathologies involving visceral arteries.Methods: 33 patients of aortic pathologies with visceral arteries who underwent endovascular aortic repair(EVAR)were retrospectively reviewed in Tianjin medical university general hospital between February 2013 and December 2017.Pre-,intra-,and post-operative clinical data were recorded.Results: 33 patients with aortic pathologies were selected in this research.The preoperative basic information or risk factors had no statistical differences(P>0.05)between two groups.Among them 30 cases were true aneurysm(90.9%),while 3patients suffered dissecting aneurysm(9.1%).In true aneurysms,2 cases of them were type ? TAAA(6.1%),and 28 cases were JAAA(84,8%).24 cases of them was operated with f-EVAR,while ch-EVAR was applied in the rest 9 cases.Besides Cheese Wire technique was applied to help fenestration in 2 cases of f-EVAR group.Total 26 stents were used in f-EVAR group,including 23 COOK,1 Medtronic and 2GORE stents.While 1 GORE and 8 COOK stents were used in ch-EVAR group.During operation,type II endoleak(f-EVAR 16.7% vs ch-EVAR 11.1%),type ?endoleak(f-EVAR 8.3% vs ch-EVAR 11.1%),lower limb arterial embolism(f-EVAR4.1% vs ch-EVAR 0%),damage of lower limbs approach(f-EVAR 8.3% vs ch-EVAR0%),renal insufficiency or aggravation(f-EVAR 8.3% vs ch-EVAR 11.1%),procedure time(f-EVAR 262.92 ± 164.10 vs ch-EVAR 190.00 ± 103.92),fluoroscopy time(f-EVAR 62.50±41.42 vs ch-EVAR 55.78±15.42),ICU stay(f-EVAR 1.54±1.02 vs ch-EVAR 1.00±0.87),hospital stay(f-EVAR 11.04±9.02 vs ch-EVAR 10.89±3.80),heart failure(f-EVAR 4.1% vs ch-EVAR 0%),thirty-day mortality(f-EVAR4.1% vs ch-EVAR 0%)had no statistical differences(P > 0.05).Besides,type I endoleak(f-EVAR 8.3% vs ch-EVAR 44.4%)got statistical criteria(P=0.034<0.05),which means f-EVAR can reduce the type I endoleak and perform better than ch-EVAR.During the follow-up period,There were no statistical differences(P>0.05)of the follow-up time(f-EVAR 11.54±5.69 vs ch-EVAR 12.44±5.53),lower limbarterial embolism(f-EVAR 4.1% vs ch-EVAR 0%),obstruction of RARA stent(f-EVAR 4.1% vs ch-EVAR 0%)and mortality(f-EVAR 4.1% vs ch-EVAR 0%).Conclusions: Both f-EVAR and ch-EVAR were feasible in aortic pathologies involving visceral arteries.F-EVAR had better effect on reconstruction of visceral arteries and reduction of type I endoleak,but the long-term follow up was needed for further results.