Anatomical feasibility of a 'semi-custom' unibody single-branch endograft in previous zone 2 thoracic endovascular aortic repair

Nicola Leone; Francesco Andreoli; Luigi A M Bartolotti; Mattia Migliari; Giovanni F Baresi; Giuseppe Saitta; Roberto Silingardi; Stefano Gennai

doi:10.1093/ejcts/ezad290

Anatomical feasibility of a 'semi-custom' unibody single-branch endograft in previous zone 2 thoracic endovascular aortic repair

Eur J Cardiothorac Surg. 2023 Oct 4;64(4):ezad290. doi: 10.1093/ejcts/ezad290.

Authors

Nicola Leone¹, Francesco Andreoli¹, Luigi A M Bartolotti¹, Mattia Migliari¹, Giovanni F Baresi¹, Giuseppe Saitta¹, Roberto Silingardi¹, Stefano Gennai¹

Affiliation

¹ Department of Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy.

PMID: 37603731
DOI: 10.1093/ejcts/ezad290

Abstract

Objectives: The aim of this study was to evaluate the suitability of a subclavian unibody single-branch endograft among patients treated with thoracic endovascular aortic repair (TEVAR) in landing zone 2 (LZ2).

Methods: This is a pre-clinical, single-centre, real-world, all-comers, retrospective cohort study. Patients treated with TEVAR in LZ2 with an available preoperative computed tomography angiography were included. The primary outcome was the anatomical feasibility of the Castor endograft in patients receiving endovascular treatment in LZ2 between 1999 and 2022. Secondary outcomes were: a comparison of feasible and unfeasible patients; frequencies and description of exclusion causes; non-feasibility risk factor analysis; and analysis of the stent graft configurations necessary to treat 75% of the patients. A logistic regression model was used to find associations between baseline morphological data and non-feasibility.

Results: A total of 473 procedures were performed and 72 patients fulfilling inclusion criteria were included. The mean distance between the left carotid artery and left subclavian artery (or between innominate artery and bovine trunk) was 12.4 ± 5.2 mm and its average diameter was 33.0 ± 10.6 mm. The pre-vertebral left subclavian artery's diameter and length were 11.3 ± 2.5 and 38.7 ± 10.8 mm. Forty-nine (68.1%) patients were suitable for Castor implantation. Twenty-one configurations were required to treat 75% of feasible patients and might be lowered to 12 configurations applying less strict criteria.

Conclusions: The Castor endograft was anatomically feasible in several patients requiring TEVAR in LZ2. Three-quarters of feasible patients could be treated with a reasonable number of configurations, paving the path for future off-the-shelf applications.

Keywords: Branched endovascular aneurysm repair; Descending thoracic aorta aneurysm; Intramural aortic haematoma; Penetrating aortic ulcer; Thoracic aortic dissection; Thoracic endovascular aortic repair.

MeSH terms

Animals
Aorta, Thoracic / diagnostic imaging
Aorta, Thoracic / surgery
Aortic Aneurysm, Thoracic* / diagnostic imaging
Aortic Aneurysm, Thoracic* / etiology
Aortic Aneurysm, Thoracic* / surgery
Aortic Dissection*
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation* / methods
Cattle
Endovascular Aneurysm Repair
Endovascular Procedures* / methods
Feasibility Studies
Humans
Prosthesis Design
Retrospective Studies
Stents / adverse effects
Treatment Outcome