Efficacy and durability of multilayer flow modulators in aortic aneurysms

english

2024

Društvo Medicinski razgledi

BACKGROUNDS. In favourable anatomical conditions, endovascular abdominal aneurysm repair (EVAR) or thoracic endovascular aortic repair (TEVAR) are the established treatments of aortic aneurysms. The treatment of other areas is more complex and demands more complex endovascular procedures or open surgery. Multilayerflow modulators (MFM) were developed to treat aortic aneurysms in areas where standard EVAR or TEVAR are not feasible. MFM implantation is simple and arterial coverage by the device should not compromise arterial flow. The aim of our study was to determine long-term efficacy and durability of MFM in the treatment of aortic aneurysms. METHODS. Our study included 16 male and one female patient, treated in a 91-month period (starting in March 2011); the follow-up period extended to March 2023. The patient mean age was 68 years and none of the patients were suitable for EVAR, TEVAR, or open surgical management. The data collection was concluded in May 2023; the median follow-up was 25 months (range 7–76 months). RESULTS. MFMs were successfully implanted in all patients, with no 30-day mortality observed. By the end of the follow-up period, five patients were alive. Three patients died due to an aortic rupture at 9th, 40th, and 51st month post-implantation, respectively. Most additional procedures were performed due to Type 1a endoleak, with one occurring within the first month, and four occurring later. During the followup, we observed occlusions of two superior mesenteric arteries, one renal artery, one subclavian artery, and one celiac trunk. Only the renal artery occlusion was symptomatic. No cases of paraplegia were detected. The mean aneurysmal flow volume was reduced in most patients (64.5%); however, this did not correspond to a reduction in mean volume or mean diameter, which increased in 59% and 88.2% of patients, respectively. CONCLUSIONS. MFMs are simple and safe to implant in patients with aortic aneurysm, however, the long-term results did not confirm the efficacy and durability of the procedure in the majority of patients. Further studies will be needed to highlight reasons for our results.

07.05.2025