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Home > Press Center > Press Releases from 2007 Annual Meeting > Stent Graft with Multiple Caudally-Directed Branches Shows Benefit

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Emily Kalata
Assistant Director, Communications
312.334.2309

A modular stent-graft that incorporates multiple caudally-directed branches to the visceral arteries to repair thoracoabdominal aortic aneurysm (TAAA) can offer a safer surgical alternative to open repair, according to a study presented at the 61st Annual Meeting of the Society for Vascular Surgery.     

University of California San Francisco researchers report that open repair is difficult because the TAAA is inaccessible and also is dangerous because the operation requires a large incision and extensive dissection. Additionally, with open repair, there is an interruption of blood flow to the lower half of the body, including abdominal organs. Timothy A. M. Chuter, MD and professor of surgery in residence in the university’s division of vascular surgery, added that the less invasive approach eliminates aneurysm flow, while preserving visceral perfusion and avoiding the main physiologic stresses.

The team at UCSF performed the first procedures of this type in 2000. “Since then the team at UCSF has used various stent-graft components connected in a number of ways,” said Dr. Chuter. “Our current technique employs springy (self-expanding) stent-grafts with overlapping segments where the components meet. The branches of the stent-graft curve downwards and outwards from the main trunk to mimic the branching pattern of a normal thoracoabdominal aorta.” 

This study reports results achieved using the current version of the device, starting in 2005. Sixteen patients
(all unfit for open repair) were successfully treated with self-expanding covered stents connecting the caudally-directed cuffs of an aortic stent-graft with the visceral branches of an aortic aneurysm (57 branches in all). Customized aortic stent-grafts were inserted through the femoral or iliac arteries, while covered stents were inserted through the brachial arteries. Routine follow-up included contrast enhanced CT scans at one week, one month, six months and one year. 

Four patients had significant perioperative complications during follow-up (mean 180 days). Two with severe longstanding chronic obstructive pulmonary disease developed pneumonia; one developed paraplegia and renal failure and died after declining dialysis; and one underwent successful re-intervention for iatrogenic aortic dissection and for Type 1 endoleak. There were no other cases of death, re-intervention, endoleak, stroke or myocardial infarction.
          
At present, said Dr. Chuter, the overall rate of perioperative death, paraplegia, stroke or renal failure is 5 percent and no stent-graft has moved, leaked, come apart, kinked, occluded, or broken during follow-up. “We believe these results warrant an expanded role for multi-branched stent-graft technology in the management of TAAA,” he said.