D'Oria Mario, Mezzetto Luca, Silingardi Roberto, Freyrie Antonio, Galeazzi Edoardo, Frigatti Paolo, Milite Domenico, Veraldi Gian Franco, Lepidi Sandro
Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy.
Department of Vascular Surgery, University Hospital of Verona, School of Medicine, University of Verona, Verona, Italy.
J Endovasc Ther. 2025 Apr;32(2):431-438. doi: 10.1177/15266028231175621. Epub 2023 May 26.
The aim of this study was to present the short-term and 2-year outcomes after use of the Bentley BeGraft as bridging stent-graft (BSG) for reno-visceral target vessel (TV) during fenestrated endovascular aortic repair (FEVAR) from a contemporary multicentric experience.
A retrospective review of all consecutive patients who underwent elective FEVAR at 7 institutions located in Italy from 2015 to 2021 was performed. The main outcomes of interest for this study were technical success and TV instability, defined in accordance with current reporting standards. Patients' survival was also assessed.
Overall, 81 patients received elective FEVAR during the study period. Mean age of patients was 78 years, and 89% were men. Most patients were treated for a juxta-pararenal abdominal aortic aneurysm (AAA) (68%), and 23% had already received an infrarenal aortic reconstruction. Most endografts had 3-vessel or 4-vessel design (27% and 55%, respectively), and a Cook endograft was used in 73% of cases. Overall, 266 Bentley BeGraft were implanted, of which 44 (16.5%) in the celiac trunk, 69 (26%) in the superior mesenteric artery, 79 (29.5%) in the right renal artery, and 74 (28%) in the left renal artery. Technical success was 94%, with 5 instances of technical failure that were recorded and required an additional intraoperative procedure. The early mortality rate was 4%, and acute kidney injury occurred in 14 cases with 1 requiring definitive hemodialysis. Survival at 6, 12, and 24 months in the overall cohort was 98.8%, 95.3%, and 83.4%, respectively. Freedom from TV instability at 6, 12, and 24 months in the overall cohort was 98.4%, 97.9%, and 97.2%, respectively. Events of TV instability included 3 cases of type 1C endoleak and 3 cases of type 3C endoleak, while no events of BSG fracture or thrombosis were noted. Five out of 6 cases of TV instability occurred in renal arteries, and they were all successfully treated by endovascular means.
The data from this multicentric study show favorable short-term and 2-year outcomes of the Bentley BeGraft as BSG for reno-visceral TV during FEVAR, with low rates of TV-related endoleak and no stent occlusion up to 2 years.Clinical ImpactThe data from this multicentric study show satsfactory outcomes up to two years of follow-up for the Bentley BeGraft when used for brdiging reno-visceral vessels during fenestrated endovascular aortic repair. Further research will be needed to identify predictors of stent-related reinterventions and ascertain the long-term durability.
本研究的目的是根据当代多中心经验，介绍在开窗式血管腔内主动脉修复术（FEVAR）期间使用Bentley BeGraft作为肾内脏目标血管（TV）的桥接支架型人工血管（BSG）后的短期和2年结局。
对2015年至2021年在意大利7家机构接受择期FEVAR的所有连续患者进行回顾性研究。本研究关注的主要结局为技术成功率和TV不稳定，按照当前报告标准进行定义。还评估了患者的生存率。
总体而言，81例患者在研究期间接受了择期FEVAR。患者的平均年龄为78岁，89%为男性。大多数患者因近肾旁腹主动脉瘤（AAA）接受治疗（68%），23%已接受肾下腹主动脉重建。大多数腔内移植物为三分支或四分支设计（分别为27%和55%），73%的病例使用了Cook腔内移植物。总体而言，共植入266枚Bentley BeGraft，其中44枚（16.5%）植入腹腔干，69枚（26%）植入肠系膜上动脉，79枚（29.5%）植入右肾动脉，74枚（28%）植入左肾动脉。技术成功率为94%，记录到5例技术失败病例，需要额外进行术中操作。早期死亡率为4%，14例发生急性肾损伤，其中1例需要进行确定性血液透析。整个队列在6个月、12个月和24个月时的生存率分别为98.8%、95.3%和83.4%。整个队列在6个月、12个月和24个月时无TV不稳定的比例分别为98.4%、97.9%和97.2%。TV不稳定事件包括3例1C型内漏和3例3C型内漏，未观察到BSG骨折或血栓形成事件。6例TV不稳定事件中有5例发生在肾动脉，均通过血管腔内方法成功治疗。
这项多中心研究的数据显示，在FEVAR期间，Bentley BeGraft作为肾内脏TV的BSG具有良好的短期和2年结局，TV相关内漏发生率低，且2年内无支架闭塞。临床影响这项多中心研究的数据显示，在开窗式血管腔内主动脉修复术期间使用Bentley BeGraft桥接肾内脏血管时，长达两年的随访结果令人满意。需要进一步研究以确定支架相关再次干预的预测因素并确定长期耐久性。
