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Long-term data demonstrate efficacy of bridging stent for F/BEVAR

In a review of 20 years of real-life experience, the Advanta V12 balloonexpandable covered stent (Getinge) has been labelled “excellent” in fenestratedbranched endovascular aortic repair (F/ BEVAR). This is according to “proven and reliable” eight-year clinical data which compared outcomes including target vessel patency, freedom from reintervention and endoleak.

AMONG SEVERAL FIRST-TIME DATA presentations at this year’s CX Symposium, Eric Verhoeven (Nuremberg, Germany) delivered the findings during the afternoon juxtarenal aortic session on Wednesday. First providing a product overview of Advanta V12, Verhoeven cast an eye back over the previous 15 years of use and design evolution, which have provided “increased flexibility, greater radial strength and lower recoil” for the restoration of iliac and renal arteries.

Covered stents “should be preferred” in chronic mesenteric ischaemia

Providing insight on the pivotal and parallel evolution within aneurysmal disease treatment, Verhoeven emphasised the move toward fenestrated and branched grafts for complex aortic aneurysms, focusing on covered stent use for FEVAR. Elaborating further, he referenced a 2009 renal fenestration study conducted by Walid Mohabbat (Sydney, Australia) et al which found that covered renal stents are associated with lower incidence of in-stent stenosis, and so are recommended for use in fenestrated or branched endografts.

Using Mohabbat as a jumping-off point, Verhoeven then moved ahead to 2015, developing the Advanta V12 timeline for the audience. Referencing his own research, he discussed a previous review of ten-year thoracoabdominal aortic aneurysm (TAAA) repair, which, of 600 target vessels, 553 (92.2%) were treated using Advanta V12, and seen to be preferable and “effective” in a high-risk patient cohort. Then, making the short leap to 2016, Verhoeven detailed his continued research into FEVAR as a first-line treatment strategy at his institution in Nuremberg. Using Advanta V12 for 99.7% of target vessels, their results showed FEVAR to be associated with “high” technical success—Verhoeven setting a salient course to contextualise their later conclusions.

Broadly looking between 2010–2020, Verhoeven proceeded to review the experience of Advanta V12 at his institution, observing its successful deployment in 83.2% of procedures. Furthermore, when relaying more granular data to the CX 2023 audience, Verhoeven highlighted the target-vessel patency rates, which were 99.1±0.2% at one year, 96.9±0.5% at five and 96.2±0.7% at eight years follow-up, respectively.

Verhoeven, dissecting these figures further, then compared patency rates between fenestrations and branches. This revealed lower patency among branches when measured against fenestrations, particularly when concerning renal arteries, which were 98.2 ±0.5% at eight years for fenestrations and 77.3±5.9% for branches.

83.2% SUCCESSFUL DEPLOYMENT

Concluding, Verhoeven made clear that despite disparities in the data, Advanta V12 has persisted as an invaluable device, which has provided “excellent” handling and flaring over the course of 20-plus years of use. Placing emphasis on the long-term patency rates that have made the Advanta V12 an invaluable tool within F/BEVAR he says, Verhoeven concluded by alluding to its steadfast place within the future of treatment.

Bridging covered stents and selfexpanding grafts “similar” in terms of primary patency and branch related endoleak

The late afternoon juxtarenal aortic consensus update session on bridging stents offered salient conclusions to the CX audience, through Luke Terlouw’s (Rotterdam, Netherlands) presentation of long-term results of a randomised controlled trial comparing covered with bare-metal stenting of the mesenteric arteries in patients with chronic mesenteric ischaemia (CMI).

Terlouw described the details of the multicentre patient- and investigator-blinded trial, noting that the study included patients undergoing endovascular treatment of atherosclerotic CMI with a stenosis length of <25mm.

He defined the trial’s primary endpoint as 24-month primary patency and specified subsequent patency loss to be luminal surface area reduction ≥75% or performance of a reintervention to maintain patency. Patency was assessed by two interventional radiologists with 15 and 19 years of experience.

Presenting the findings, Terlouw confirmed that, considering the follow-up data show “significantly” better primary patency and lower reintervention rates, the covered stent should be regarded as the preferred stent when treating patients with atherosclerotic CMI.

KONSTANTINOS SPANOS (LARISSA, GREECE) PRESENTED META-ANALYSIS DATA of comparative studies evaluating balloon-expandable bridging covered stent versus self-expanding stent grafts for branched endovascular aneurysm repair (BEVAR) in a Podium First on Wednesday afternoon. The findings show that bridging covered and self-expanding stents perform “similarly” when compared via primary patency and branch-related endoleak during mid-term follow-up.

Addressing the CX 2023 audience, Spanos explained that currently available stent grafts— bridging covered stents or self-expanding grafts—are not originally designed as bridging stents for complex aortic repair with branched devices. Continuing, he outlined the aim of the current review was to evaluate the impact of each type of bridging stent graft on target vessel outcomes during the mid-term follow-up after BEVAR.

In total, Spanos stated, 96% of target vessels remained patent using bridging covered stents and 97% using self-expanding grafts, and he added the overall pooled primary patency rate did not differ between groups. Concerning revascularisation, Spanos also asserted that no significant differences were found between the two groups, showing 97% for bridging covered stents and 99% for selfexpanding grafts, respectively.

Of note however, Spanos confirmed that the researchers found a lower risk for target vessel instability using self-expanding stent grafts during revascularisation when compared to bridging covered stents, which he defined as any death or rupture related to a side-branch complication.

Concluding his presentation, Spanos conveyed that although performance of bridging covered stents versus self-expanding stent grafts was similar, current data from retrospective studies suggest that overall target vessel instability and reintervention rates are favourable for self-expanding grafts as bridging stent grafts in BEVAR. Finally, Spanos remarked that further research in the form of randomised controlled trials may be needed in this area.

• Small aortic bifurcations

• Excellent control of distal alignment

• 0-90o infrarenal angle

• Pararenal sealing

• Conformable leg extension design

• Ultra-low profile 14Fr delivery system

• Fully re-positional for accurate placement

• Trimodular design

• Helical leg extension design

• Ultra-low profile

• Leave-behind sheath