Stellenwert der „inner Branches“ in der komplexen endovaskulären Aortenchirurgie

Zusammenfassung

Die komplexe endovaskuläre Therapie der Aorta mit fenestrierten und gebranchten Prothesen spielt eine wichtige Rolle in der heutigen Gefäßmedizin. Daraus resultieren innovative medizintechnische Lösungen, die für immer anspruchsvollere Aortenpathologien eingesetzt werden. Das Ziel dieser Arbeit war es, die zunehmende Bedeutung der „inner Branches“ in der komplexen Aortenchirurgie darzustellen. Die Vorteile und Grenzen dieser Technik sollten aufgezeigt und die aktuelle Datenlage zusammengefasst werden. Dazu wurden die „inner Branches“ (iBEVAR) den Standardverfahren (Fenestrationen [FEVAR], „outer Branches“ [BEVAR]) gegenübergestellt und ihre technischen Vor- und Nachteile erarbeitet. Kennzeichnend ist der weit verbreitete Einsatz der iBEVAR im Aortenbogen im Gegensatz zur thorakoabdominellen Aorta, was sich auch in der spärlichen Datenlage im thorakoabdominellen Abschnitt widerspiegelt. Die Letztere basiert auf kleineren retrospektiven Studien mit 1-jährigem Follow-up. Die seit 2 Jahren verfügbare thorakoabdominelle „off-the-shelf“-Prothese wird voraussichtlich zu einer weiteren Verbreitung der „inner Branches“ im thorakoabdominellen Abschnitt führen, wobei die von der Industrie geförderte Registerstudie wichtige Evidenz zur erörterten Technik bereitstellen könnte.

Abstract

Complex endovascular therapy of the aorta with fenestrated and branched endografts plays an essential role in modern vascular medicine. Innovative solutions for demanding aortic pathologies are therefore being constantly developed by the medical industry. The aim of this manuscript is to illustrate the growing importance of the inner branches in complex aortic repair and to show the advantages and limits of this technique with an overview of the current literature. The inner branches (iBEVAR) were therefore compared to the standard treatment options (fenestrations; [FEVAR], outer branches [BEVAR]) and the technical advantages of all platforms were evaluated. The widespread use of iBEVAR in the aortic arch stands in contrast to the thoracoabdominal aorta, which is mirrored by the scarce evidence for the thoracoabdominal inner branches. The published experience is based on smaller retrospective studies with a 1-year follow-up. The E-nside (Artivion, Hechingen, Germany) thoracoabdominal off-the-shelf inner-branch-based endograft was released 2 years ago. Its widespread deployment may increase the use of the inner branches in the thoracoabdominal aorta. Moreover, an ongoing industry-funded registry may provide new insights into the long-term durability of this innovative technique.

Schlüsselwörter

Stentprothese - Aortenchirurgie - Aortenaneurysma - endovaskuläre Therapie - Aortenstentprothese

Keywords

stent prosthesis - endovascular treatment - aortic aneurysm - aortic stent prosthesis - aortic surgery

Publication History

Received: 15 July 2022

Accepted: 23 August 2022

Article published online:
11 October 2022

• Literatur

• 1 Riambau V, Böckler D, Brunkwall J. et al. Editor’s Choice – Management of Descending Thoracic Aorta Diseases: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2017; 53: 4-52 DOI: 10.1016/j.ejvs.2016.06.005. (PMID: 28081802)
• 2 Wanhainen A, Verzini F, Van I Herzeele. et al. Editor’s Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg 2019; 57: 8-93 DOI: 10.1016/j.ejvs.2018.09.020. (PMID: 30528142)
• 3 Griepp RB, Ergin MA, Galla JD. et al. Looking for the artery of Adamkiewicz: a quest to minimize paraplegia after operations for aneurysms of the descending thoracic and thoracoabdominal aorta. J Thorac Cardiovasc Surg 1996; 112: 1202-1213 DOI: 10.1016/s0022-5223(96)70133-2. (PMID: 8911316)
• 4 Bisdas T, Donas KP, Bosiers M. et al. Anatomical suitability of the T-branch stent-graft in patients with thoracoabdominal aortic aneurysms treated using custom-made multibranched endografts. J Endovasc Ther 2013; 20: 672-677 DOI: 10.1583/13-4400MR.1. (PMID: 24093320)
• 5 Andic M, Lescan M. Staged Hybrid Treatment with Branched Endovascular Aneurysm Repair of a Thoracoabdominal Aortic Aneurysm in the Presence of a Total Infrarenal Aortoiliac Occlusion. Vasc Specialist Int 2021; 37: 43 DOI: 10.5758/vsi.210064. (PMID: 34983027)
• 6 Squizzato F, Antonello M, Forcella E. et al. Geometrical determinants of target vessel instability in fenestrated endovascular aortic repair. J Vasc Surg 2022; 76: 335-343.e2 DOI: 10.1016/j.jvs.2022.01.146. (PMID: 35276259)
• 7 Lescan M. Endovaskuläre Therapie der komplexen thorakalen Aortenpathologien mit Bogenbeteiligung. Gefässchirurgie 2021; 26: 270-277 DOI: 10.1007/s00772-021-00788-8.
• 8 Zimmermann A, Menges AL, Rancic Z. et al. E-nside Off-the-Shelf Inner Branch Stent Graft: Technical Aspects of Planning and Implantation. J Endovasc Ther 2022; 29: 167-174 DOI: 10.1177/15266028211047967. (PMID: 34569343)
• 9 Katsargyris A, Marques de Marino P, Mufty H. et al. Early Experience with the Use of Inner Branches in Endovascular Repair of Complex Abdominal and Thoraco-abdominal Aortic Aneurysms. Eur J Vasc Endovasc Surg 2018; 55: 640-646 DOI: 10.1016/j.ejvs.2018.01.024. (PMID: 29545020)
• 10 Andic M, Mustafi M, Schlensak C. et al. Total transfemoral access in a new off-the-shelf thoracoabdominal inner-branched endograft. Eur J Cardiothorac Surg 2022; DOI: 10.1093/ejcts/ezac136. (PMID: 35257145)
• 11 Schaefers JF, Murtaja A, Oberhuber A. Retrograde Approach for Antegrade Inner Branches in a Precannulated Off-the-Shelf Multibranch Device. J Endovasc Ther 2022; 29: 512-515 DOI: 10.1177/15266028211059452. (PMID: 34836476)
• 12 Khan S, Lombardi JV, Carpenter JP. et al. Open abdominal aortic aneurysm repair is still necessary in an era of advanced endovascular repair. J Vasc Surg 2016; 64: 333-337 DOI: 10.1016/j.jvs.2016.02.027. (PMID: 27183852)
• 13 Jansen MM, van der Stelt M, Smorenburg SPM. et al. Target vessel displacement during fenestrated and branched endovascular aortic repair and its implications for the role of traditional computed tomography angiography roadmaps. Quant Imaging Med Surg 2021; 11: 3945-3955 DOI: 10.21037/qims-20-1077. (PMID: 34476180)
• 14 Eleshra A, Oderich GS, Spanos K. et al. Short-term outcomes of the t-Branch off-the-shelf multibranched stent graft for reintervention after previous infrarenal aortic repair. J Vasc Surg 2020; 72: 1558-1566 DOI: 10.1016/j.jvs.2020.02.012. (PMID: 32423775)
• 15 Abisi S, Zymvragoudakis V, Gkoutzios P. et al. Early outcomes of Jotec inner-branched endografts in complex endovascular aortic aneurysm repair. J Vasc Surg 2021; 74: 871-879 DOI: 10.1016/j.jvs.2021.01.067. (PMID: 33647435)
• 16 Negmadjanov U, Motta JC, Lee WA. Total endovascular aortic arch repair using the Terumo Aortic triple-branch arch endograft. Ann Vasc Surg 2021; 77: 351.e7-351.e14 DOI: 10.1016/j.avsg.2021.05.044. (PMID: 34437959)
• 17 Tenorio ER, Oderich GS, Kolbel T. et al. Multicenter global early feasibility study to evaluate total endovascular arch repair using three-vessel inner branch stent-grafts for aneurysms and dissections. J Vasc Surg 2021; 74: 1055-1065.e4 DOI: 10.1016/j.jvs.2021.03.029. (PMID: 33865950)
• 18 Haulon S, Greenberg RK, Spear R. et al. Global experience with an inner branched arch endograft. J Thorac Cardiovasc Surg 2014; 148: 1709-1716 DOI: 10.1016/j.jtcvs.2014.02.072. (PMID: 24685375)
• 19 Tsilimparis N, Detter C, Law Y. et al. Single-center experience with an inner branched arch endograft. J Vasc Surg 2019; 69: 977-985.e1 DOI: 10.1016/j.jvs.2018.07.076. (PMID: 30477941)
• 20 Verscheure D, Haulon S, Tsilimparis N. et al. Endovascular Treatment of Post Type A Chronic Aortic Arch Dissection With a Branched Endograft: Early Results From a Retrospective International Multicenter Study. Ann Surg 2021; 273: 997-1003 DOI: 10.1097/SLA.0000000000003310. (PMID: 30973389)
• 21 Czerny M, Berger T, Kondov S. et al. Results of endovascular aortic arch repair using the Relay Branch system. Eur J Cardiothorac Surg 2021; 60: 662-668 DOI: 10.1093/ejcts/ezab160. (PMID: 33956958)
• 22 Benfor B, Prendes CF, Peterss S. et al. Anatomical analysis of the aortic arch and feasibility study of double and triple branched thoracic endografts in the treatment of isolated arch pathologies. Eur J Cardiothorac Surg 2022; DOI: 10.1093/ejcts/ezac246. (PMID: 35413109)
• 23 Silverberg D, Bar-Dayan A, Hater H. et al. Short-term outcomes of inner branches for endovascular repair of complex abdominal and thoracoabdominal aortic aneurysms. Vascular 2021; 29: 644-651 DOI: 10.1177/1708538120977279. (PMID: 33292087)
• 24 Bilman V, Cambiaghi T, Grandi A. et al. Anatomical feasibility of a new off-the-shelf inner branch stent graft (E-nside) for endovascular treatment of thoraco-abdominal aneurysms. Eur J Cardiothorac Surg 2020; 58: 1296-1303 DOI: 10.1093/ejcts/ezaa276. (PMID: 33057585)
• 25 Bertoglio L, Grandi A, Carta N. et al. Comparison of anatomic feasibility of three different multibranched off-the-shelf stent-grafts designed for thoracoabdominal aortic aneurysms. J Vasc Surg 2021; 74: 1472-1482.e4 DOI: 10.1016/j.jvs.2021.04.066. (PMID: 34023432)
• 26 Tsilimparis N, Law Y, Rohlffs F. et al. Fenestrated endovascular repair for diseases involving the aortic arch. J Vasc Surg 2020; 71: 1464-1471 DOI: 10.1016/j.jvs.2019.06.205. (PMID: 32063444)
• 27 Sato H, Fukada J, Tamiya Y. et al. Long-Term Clinical Outcomes of Thoracic Endovascular Aortic Repair for Arch Aneurysms with the Najuta Thoracic Stent-Graft System. Ann Vasc Dis 2020; 13: 384-389 DOI: 10.3400/avd.oa.20-00102. (PMID: 33391555)
• 28 Fernández-Alonso L, Fernández Alonso S, Martínez Aguilar E. et al. Fenestrated and Scalloped Endovascular Grafts in Zone 0 and Zone 1 for Aortic Arch Disease. Ann Vasc Surg 2020; 69: 360-365 DOI: 10.1016/j.avsg.2020.06.009. (PMID: 32554200)