Use of the AFX Stent Graft in Patients with Extremely Narrow Aortic Bifurcation: A Multicenter Retrospective Study

Abstract

Introduction. This study analyzed the patient outcomes following endovascular aortic aneurysm repair (EVAR) for infrarenal aortic pathologies with very narrow aortic bifurcations using the AFX stent graft. Methods. The data was retrieved from the archived medical records of 35 patients treated for abdominal aortic aneurysm (AAA) (48.6%) or penetrating aortic ulcer (PAU) (51.4%) with very narrow aortic bifurcation between January 2013 and May 2020. Patient survival, freedom from endoleak (EL), and limb occlusion were estimated applying the Kaplan–Meier method. Results. The mean follow-up time was $20.4\pm 22.8$ months. The mean aortic bifurcation diameter was $15.8\pm 2.2\text{mm}$ . Technical success was 100%, and no procedure-related deaths occurred. Two type II ELs occurred within 30-day follow-up. We observed one common iliac artery stenosis at four months and one type III EL at 54 months in the same patient, both of which required re-intervention. Overall patient survival was $95\pm 5\%$ (AAA: 100%; PAU: $89\pm 10\%$ ), freedom from limb occlusion was $94\pm 5\%$ (AAA: $91\pm 9\%$ ; PAU: 100%), freedom from type II EL was $94\pm 4\%$ (AAA: $88\pm 8\%$ ; PAU: 100%), and freedom from EL type III was $83\pm 15\%$ (AAA: $80\pm 18\%$ ; PAU: 100%) at the end of the follow-up period. Conclusions. Very narrow aortic bifurcations may predispose patients to procedure-related complications following EVAR. Our results suggest a safe use of the AFX stent graft in such scenarios. The overall short- and long-term procedure-related patient outcomes are satisfying albeit they may seem superior for PAU when compared to AAA.