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Home > Vascular Annual Meeting > RR31. Proximal Oversizing in TEVAR: Does Oversizing...

RR31. Proximal Oversizing in TEVAR: Does Oversizing Affect Outcomes?

Elena Y. Rakhlin, Jason Reynolds, Robert Hill, Joseph E. Bavaria, Ronald M. Fairman, Edward Y. Woo
Hospital of University of Pennsylvania, Philadelphia, PA

OBJECTIVES: TEVAR is a widely accepted treatment for thoracic aneurysms, yet some of the technical guidelines need to be defined. Oversizing allows for proximal apposition and seal. However, 10-20% oversizing may not be feasible in dilated or small aortas. We examine the impact of proximal oversizing on outcomes.

METHODS: In the VALOR trial (Medtronic, Minneapolis, MN) 188 patients with TAA were treated with a Talent device. Ages ranged 18-85 years (70±10; 59% male). Patients were divided into 3 oversizing groups: A – <10% (28), B – 10-20% (66), C – >20% (94). Group B (67%) had more fusiform aneurysms (p=0.02). Proximal neck shape (p=0.4), thrombus (p=1), and calcification (p=0.9) were comparable. Comorbidities were similar. Data were analyzed at 30 days and 1 year.

RESULTS: Endografts were successfully deployed in all patients. The extent of oversizing inversely correlated with proximal neck diameter (p<0.001). When comparing the 3 groups, procedure duration (p=0.94) and intra-operative blood loss (p=0.92) were comparable. The 30-day and 1 year mortality, aneurysm-related and overall, were similar. No significant difference was noted in perioperative paraplegia, CVA, and cardiac events. Although, there was a trend toward increased frequency of endoleaks in Group A, this did not reach statistical significance (p=0.1). Graft migration, and aneurysm growth also did not vary statistically among groups (p=0.81, p=0.77, respectively). Five percent underwent secondary endovascular interventions (p=0.81), and only one patient (Group A) was converted to open surgical repair (p=0.06). All endografts were patent at 1 year. When comparing Groups A or C to B alone, no statistically significant differences were noted (Table 1).

CONCLUSIONS: In this study, >50% of patients were oversized by <10% or >20%. However, this “deviation” from the recommended practice of 10-20% did not affect outcomes. Thus, variations of oversizing may be acceptable in the treatment of thoracic aneurysms when standard oversizing cannot be achieved.

AUTHOR DISCLOSURES: E.Y. Rakhlin, None; J. Reynolds, None; R. Hill, None; J.E. Bavaria, None; R.M. Fairman, None; E.Y. Woo, None.

Table 1.