Latin America comes to CX 2023

LEADERS IN VASCULAR disease from Argentina, Brazil and further afield came together for the inaugural CX Meets Latin America session, taking place on Tuesday morning in Mezzanine 10. Session chair Bruno Freitas (Leipzig, Germany) was joined by an international panel of moderators including Luiz Furuya (Sao Paulo, Brazil), Frans Moll (Utrecht, Netherlands) and Sophie Renton (London, United Kingdom), who oversaw a vibrant session taking in the latest perspectives from Latin America on topics spanning aortic and peripheral procedures.

Freitas opened the session with a presentation covering complex multilevel chronic limb-threatening ischaemia, in which he opened the toolbox to offer technical tips to overcome challenging scenarios. Results of an in-situ fenestration technique for preservation of the left subclavian artery in the endovascular repair of acute aortic syndromes were delivered by Andre Pinheiro (Bahia, Brazil), followed by a case report from Tony Furuie (Sao Paulo, Brazil) concerning ipsilateral iliac branch repair

Aortic device conformability: Adapting to the anatomy for better clinical outcomes

During one of yesterday’s satellite symposia at CX, speakers addressed the “key factor” of conformability in the endovascular repair of multiple vascular pathologies.

First to address the audience, Michele Antonello (Padua, Italy) argued that true conformability can reduce the risk of distal sine in the endovascular repair of type B aortic dissection (TBAD). Speaking to CX Daily News ahead of CX, Antonello remarked that conformability is a “key factor” in device selection, and especially so in relation to TBAD as the aorta is more “fragile” in this pathology. “Theoretically,” the presenter explained, “the less you try to modify the anatomy of the aorta, the less the endograft will shock the adventitia.”

Antonello explained that the GORE® TAG® Conformable Thoracic Stent Graft with ACTIVE CONTROL System “keeps the curvature of the arch of the aorta” and stays in the position to which it is moved. This has the effect of reducing the possibility of trauma to the aortic wall, Antonello noted. In addition, Antonello detailed that there is a theoretically lower risk of a new dissection created by the TAG Conformable Device than with a standard device.

Data from the GREAT Registry of a real-world population have shown that the TAG Conformable Device has a low distal sine rate of 4% in chronic TBAD aortic dissection patients, Antonello communicated with the audience at CX. The results from this study are “particularly good,” he shared with this newspaper, citing low incidence of three events: neurological complications, new endoleaks and new dissections created by the endograft. “I think [the TAG

Conformable Device] is the only endograft that has such robust data coming from a real-life registry.” Later in the symposium, Jan Heyligers (Tilburg, Netherlands) addressed the question ‘Does conformability have an impact on the outcomes of endovascular repair of iliac limb performance?’ In an interview with CX Daily News, Heyligers remarked that conformability is important in treating iliac pathology since the flow and curvature of the iliacs are challenging. “We are aiming to have a device that is conformable to the anatomy.”

According to Heyligers, there are differences in conformability in the iliac branch devices (IBDs) available on the market. “There are some devices that are stiffer than others,” he explained, noting that the GORE® EXCLUDER® Iliac Branch Endoprosthesis (IBE) seems to be the most conformable to the actual anatomy, based on his clinical experience with the device.

Heyligers detailed that he and his team have researched the Gore endograft in tortuous anatomy. He shared, for example, that in one study they implanted 17 IBEs and conducted electrocardiography (ECG)-gated computed tomography (CT) analysis preand postoperatively. “We have learned using a looped wire—what he described as a precannulated gate technique.

Later in the session, Mariano Castelli (Buenos Aires, Argentina) spoke on predictors of type IIIa endoleak after endovascular aneurysm repair (EVAR) with an anatomic fixation endograft, after which Luiz Furuya (Sao Paulo, Brazil) delivered a presentation on a bridged stent for fenestrated EVAR (FEVAR) and branched EVAR (BEVAR), addressing the question ‘Is there really a difference between them?’ Castelli delivered the penultimate presentation, which focused on FEVAR with a physician-modified endograft after previous failed EVAR in an emergent setting. Finally, Freitas considered current evidence and technical insights on intramural haematoma and penetrating aortic ulcer. All presentations were punctuated with audience participation and discussion, and the session closed with a roundtable that after implantation of an IBE there is a significant increase in motion,” he reported.

“In general, the more straightforward your anatomy is, the more probable it is that your device will endure,” Heyligers remarked. Then again, he noted that the more adapted the system is to the anatomy, the more likely it is to translate into good outcomes, irrespective of the anatomy. The IBE is a “proven solution” in this regard, he said in summary.

Giovanni Pratesi (Genoa, Italy) also spoke during the session, sharing his insights on the impact of conformability on the outcomes of endovascular repair of abdominal aortic aneurysm (AAA) with angulated infrarenal necks.

In endovascular aneurysm repair (EVAR), Pratesi told CX Daily News, conformability is “intrinsic” to how a stent graft adapts to a patient’s anatomy and can improve procedural outcomes.

During the symposium, Pratesi discussed three-year follow-up data from the European multicentre EXCeL registry on the GORE® EXCLUDER® Conformable AAA Endoprosthesis with ACTIVE CONTROL System, noting how it adds to the long-term evidence from numerous trials and registries worldwide that support the efficacy of all Gore conformable devices.

Postoperative angio-CT showing true lumen expansion and optimal visceral perfusion after thoracic endovascular aortic repair with the GORE TAG.

The indication to treat challenging anatomies within the Instructions for Use (IFU) is “undoubtedly” an advantage of the GORE EXCLUDER Conformable Device, Pratesi remarked. In particular, he explained, the device allows for the treatment of short as well as severely angulated necks, offering the capability to treat anatomy previously considered unsuitable for standard EVAR.