Sherif Sultan1, Niamh Hynes2, Wael Tawfick1
1Vascular & Endovascular Surgery, Western Vascular Institute, Galway, Ireland; 2Galway Clinic, Galway, Ireland.
OBJECTIVES: Patients with Thoraco-abdominal Aortic Aneurysm have been classically managed by open surgical repair since 1955 but despite advances in surgical technique and the introduction of less invasive endovascular techniques, morbidity and mortality rates remain high. We report outcome using a novel uni-modular multi-layer stent technology.
METHODS: Out of 172 cases implanted worldwide we present the first 26 cases, in 7 countries, that were fully analyzed through the MFM registry. All were Crawford Thoraco-abdominal aortic aneurysms (11 Type II, 9 Type III, and 6 Type IV); 75% were male; median age was 73years (57-91); 79.7% were ASA IV E; 62 % were reintervention after previous TEVAR; mean aneurysm diameter was 67mm and mean length was 167 mm.
RESULTS: All stents were deployed to their intended target. No Aneurysm-related death occurred within 18 months. No peri-operative Visceral or Renal insult occurred. There were no Cerebrovascular accidents, paraplegia or loss of visceral branches patency during follow up.
At 6 months, mean sac volume shrunk by 8% with lumen volume reduction of 14%. Average thrombus volume increased but thrombus to lumen ratio decreased by 23%.
Finite Element Analysis post MFM documented dampening of wall displacement by 80%. Wall pressure fell to 200 Pa with immediate depressurization of the aortic sac and dissipation of the maximum pressure zone. There was 55% immediate reduction in Wall Stress.
CONCLUSIONS: MFM carries no risk of critical shuttering or loss of native side branches. With physiological modulation of the aneurysm, Volume Sac reduction was documented in 65% of cases. MFM offers immense promise for resolution of complex Thoraco-abdominal aneurysms.
AUTHOR DISCLOSURES: N. Hynes, Nothing to disclose; S. Sultan, Nothing to disclose; W. Tawfick, Nothing to disclose.
Posted April 2012