Vascular and Endovascular Surgery Division - “Sapienza” University of RomeVascular and Endovascular Surgery Division - “Sapienza” University of RomeVascular and Endovascular Surgery Division - “Sapienza” University of Rome

UTILIZZO DI AFX (ENDOLOGIX) STENTGRAFT IN

PAZIENTI CON PATOLOGIA AORTO-ILIACA TASC-D

E ANEURISMA DELL’AORTA ADDOMINALE

C.F. Porreca, P. Sirignano, W. Mansour, M. Formiconi,

M. Brunoro, L. Capoccia, F. Speziale

Vascular and Endovascular Surgery Division

Department of Surgery “Paride Stefanini” - Policlinico Umberto I

“Sapienza” University of Rome

Chief Prof F Speziale

Vascular and Endovascular Surgery Division - “Sapienza” University of Rome

TASC II, J Vasc Surg, 2007

UTILIZZO DI AFX (ENDOLOGIX) STENTGRAFT

IN PAZIENTI CON AOID TASC-D E AAA

Vascular and Endovascular Surgery Division - “Sapienza” University of Rome

TASC II, J Vasc Surg, 2007

UTILIZZO DI AFX (ENDOLOGIX) STENTGRAFT

IN PAZIENTI CON AOID TASC-D E AAA

Vascular and Endovascular Surgery Division - “Sapienza” University of Rome

Despite TASC II several Authors have

proposed an endovascular approach for TASC

D lesions.

Consequently, endovascular techniques are

becoming a first-line therapy due to the

potential to provide a less invasive treatment

associated with reduced morbidity and

mortalitySharafuddin MJ et al . AVS 2008

de Donato G, et al al AVS 2015

Maldonado TS, et al. EJVS 2016

Dijkstra ML, et al. JEVT 2017

UTILIZZO DI AFX (ENDOLOGIX) STENTGRAFT

IN PAZIENTI CON AOID TASC-D E AAA

Vascular and Endovascular Surgery Division - “Sapienza” University of Rome

The most widely

investigated procedure for

this indication, “kissing

stents” demonstrates good

results, despite technical

challenges and increasing

procedure complexity.

UTILIZZO DI AFX (ENDOLOGIX) STENTGRAFT

IN PAZIENTI CON AOID TASC-D E AAA

Vascular and Endovascular Surgery Division - “Sapienza” University of Rome

Moreover, kissing stent patency may be

compromised due to radial size mismatch between

the stents and the distal aorta

UTILIZZO DI AFX (ENDOLOGIX) STENTGRAFT

IN PAZIENTI CON AOID TASC-D E AAA

Vascular and Endovascular Surgery Division - “Sapienza” University of Rome

The Covered Endovascular

Reconstruction of the Aortic

Bifurcation (CERAB) technique

was developed to overcome the

anatomical and physiological

disadvantages of kissing stents.

UTILIZZO DI AFX (ENDOLOGIX) STENTGRAFT

IN PAZIENTI CON AOID TASC-D E AAA

Vascular and Endovascular Surgery Division - “Sapienza” University of Rome

UTILIZZO DI AFX (ENDOLOGIX) STENTGRAFT

IN PAZIENTI CON AOID TASC-D E AAA

Vascular and Endovascular Surgery Division - “Sapienza” University of Rome

91 AIOD lesions (74 TASC D)

100% technical success

9 reintervention during follow-up

Maldonado TS, et al. EJVS 2016

UTILIZZO DI AFX (ENDOLOGIX) STENTGRAFT

IN PAZIENTI CON AOID TASC-D E AAA

Patients with concomitant AAA >3.5cm

were excluded

Vascular and Endovascular Surgery Division - “Sapienza” University of Rome

To evaluate role of the AFX

stent-graft implantation in

patients with TASC-D AIOD and

coexistent Abdominal Aortic

Aneurysms

AIM

UTILIZZO DI AFX (ENDOLOGIX) STENTGRAFT

IN PAZIENTI CON AOID TASC-D E AAA

Vascular and Endovascular Surgery Division - “Sapienza” University of Rome

January 2013 – December 2016

21 TASC D+AAA / 93 AIOD

Rutherford Category 2 4pts

3 14pts

4 3pts

UTILIZZO DI AFX (ENDOLOGIX) STENTGRAFT

IN PAZIENTI CON AOID TASC-D E AAA

STUDY POPULATION

Vascular and Endovascular Surgery Division - “Sapienza” University of Rome

UTILIZZO DI AFX (ENDOLOGIX) STENTGRAFT

IN PAZIENTI CON AOID TASC-D E AAA

21 PatientsAge 73.6±6.4 (57-89)

Male Sex 17; 80.9%

Hypertension 18; 85.7%

Dyslipidaemia 14; 66.7%

Diabetes 13; 61.9%

CAD 9; 42.8%

Smoke 16; 76.2%

COPD 9; 42.9%

CRI 7; 33.3%

ASA III/IV 8; 38.1%

STUDY POPULATION

Vascular and Endovascular Surgery Division - “Sapienza” University of Rome

AAA diameter 36.2±3.8mm

Bifurcation diameter 13±2.3mm

UTILIZZO DI AFX (ENDOLOGIX) STENTGRAFT

IN PAZIENTI CON AOID TASC-D E AAA

STUDY POPULATION

4 occlusion, 1 bilateral

14 sever stenosisCIA

EIA

SFA

2 occlusion, no bilateral

18 severe stenosis

6 occlusions, 1 bilateral

Vascular and Endovascular Surgery Division - “Sapienza” University of Rome

Stenoses Dilatation AFX Implantation

Occlusion controlateral recanalization

(intraluminal whenever possible)

dilatation AFX Implantation

No brachial/axillary access

No re-entry devices

UTILIZZO DI AFX (ENDOLOGIX) STENTGRAFT

IN PAZIENTI CON AOID TASC-D E AAA

METHODS

Vascular and Endovascular Surgery Division - “Sapienza” University of Rome

Outcome measures:

clinical* and technical success

30-day and midterm patency

*Clinical success was defined as improvement in

ABI 2 or more Rutherford Cathegories

UTILIZZO DI AFX (ENDOLOGIX) STENTGRAFT

IN PAZIENTI CON AOID TASC-D E AAA

METHODS

Vascular and Endovascular Surgery Division - “Sapienza” University of Rome

100% technical and clinical success

Intraluminal recanalization in 2 CIA

occlusions (1 retrograde)

5 patients required suprarenal fixation

No CIA stenting

18 EIAs required stenting

UTILIZZO DI AFX (ENDOLOGIX) STENTGRAFT

IN PAZIENTI CON AOID TASC-D E AAA

RESULTS

Vascular and Endovascular Surgery Division - “Sapienza” University of Rome

30-day follow-up

No high-flow endoleaks

All AFX devices patent

All patients improvement >2 Rutherford category

UTILIZZO DI AFX (ENDOLOGIX) STENTGRAFT

IN PAZIENTI CON AOID TASC-D E AAA

RESULTS

Vascular and Endovascular Surgery Division - “Sapienza” University of Rome

Mean follow-up

25.2±11.1months (range 5–40)

All treated vessels were patent

Rutherford categories were 0 3pts

1 17pts

2 1pts

UTILIZZO DI AFX (ENDOLOGIX) STENTGRAFT

IN PAZIENTI CON AOID TASC-D E AAA

RESULTS

Vascular and Endovascular Surgery Division - “Sapienza” University of Rome

Our data seem to support the use of

the AFX stent-graft in this subgroup

of patients with TASC D AIOD and AAA,

with satisfactory midterm results and

acceptable risk for patients.

UTILIZZO DI AFX (ENDOLOGIX) STENTGRAFT

IN PAZIENTI CON AOID TASC-D E AAA

CONCLUSION

Vascular and Endovascular Surgery Division - “Sapienza” University of Rome

Symposium Chairman

Francesco Speziale

Scientific Secretariat

Laura Capoccia

Wassim Mansour

Pasqualino Sirignano

Vascular and Endovascular

Surgery Division

Department of Surgery

“Paride Stefanini”

“Sapienza” University of Rome

Policlinico Umberto I

e-mail: caput.meeting@gmail.com

Thank you