Geometric changes over time in bridging stents after branched and fenestrated endovascular repair for thoracoabdominal aneurysm.

OBJECTIVE: The objective of this study was to assess long-term durability of bridging stents in branched and combined branched and fenestrated endovascular aneurysm repair (B/F-EVAR) for thoracoabdominal aortic aneurysm (TAAA) and pararenal abdominal aortic aneurysm. METHODS: A retrospective database analysis was performed of patients treated by B/F-EVAR for TAAA. Computed tomography angiography images were analyzed to assess patency, bridging stent angulation and migration, aneurysm diameter, and migration of the endograft. RESULTS: Twenty-eight patients with a median age of 70 years (interquartile range [IQR], 67-77 years) were included. Assisted technical success was 89%. Within 30 days postoperatively, five patients died. In the remaining 23 patients, median follow-up was 5.3 years (IQR, 2.9-7.2 years), and 1-, 3-, and 5-year estimated overall survival was 69%, 65%, and 44%, respectively. During follow-up, 12 of 47 (26%) branches occluded and 5 of 47 (11%) branches developed a 70% to 99% stenosis. The 1-, 3-, and 5-year estimated freedom from adverse events was 78%, 76%, and 59% for branch stents and 100%, 96%, and 90% for fenestration stents, respectively. The median distal bridging stent migration was 0.5 mm (IQR, -1.9 to 1.4; P > .05 mm). In 10 branches, migration >10 mm was seen, ranging from 14.1 mm sliding in to 23.0 mm sliding out. The angulation between branch and stent became 4 degrees more angulated (IQR, -14 to +2 degrees). In 23 branches, the angulation changed 10 degrees or more, leading to an occlusion in 7 branches, a 70% to 99% stenosis in 3 branches, and a 50% to 70% stenosis in 4 branches. In three cases, the endograft migrated >5 mm caudally, with a breach in a fenestration stent in one and a breach in a branch stent in another. CONCLUSIONS: The anatomic configuration of branches in B/F-EVAR of TAAAs and pararenal abdominal aortic aneurysms changes over time. The change in angle of branches and the bridging stent influences the likelihood of stenosis and occlusion. Follow-up of B/F-EVAR should include computed tomography angiography measurements of aortic diameter, endograft migration, target vessel stent length, and angulation to detect disconnection, stenosis, and occlusion.

Long-term functional outcome after type A3 spinal fractures: operative versus non-operative treatment.

The authors retrospectively studied, by questionnaires, the long-term (5 years) functional outcome after operative (posterior instrumentation: 38 cases) and non-operative treatment (25 cases) for type A3 spinal fractures (Comprehensive Classification) without neurological deficit. A possible bias of this study was the fact that the operative group included 60% A3.2 and A3.3 fractures, versus only 12% in the nonoperative group. Two disease-specific questionnaires were used: the Visual Analogue Scale Spine Score and the Roland-Morris Disability Questionnaire. At follow-up the mean VAS scores were 82.6 and 80.8 in the operatively and non-operatively treated group, respectively; the difference was not significant. The mean RMDQ scores were 3.3 and 3.1 in the operatively and non-operatively treated groups, respectively; again the difference was not significant. Functional outcome appeared to be equally good five years after operative or non-operative treatment of type A3 "burst" fractures.