Early Experience with the Octopus Endovascular Strategy in the Management of Thoracoabdominal Aneurysms. Annals of vascular surgery Dua, A., Lavingia, K. S., Deslarzes-Dubuis, C., Dake, M. D., Lee, J. T. 2019


OBJECTIVES: The Octopus endovascular strategy involves placement of multiple, stacked bifurcated grafts in the thoracic segment of a TAAA to facilitate deployment of multiple parallel covered stents for visceral perfusion. This study aimed to review early outcomes of the Octopus TAAA repair strategy at a tertiary, high volume referral center.METHODS: All patients who underwent this Octopus procedure from 2015 to 2018 were reviewed from a prospectively collected single institution registry. Demographics, comorbidities, aneurysm anatomy including side and extent, peri-operative data including blood loss, length of procedure length of stay (LOS), morbidity, and mortality up to 3 years post procedure were elevated.RESULTS: A total of 21 patients (48% female, age 72.9 years) underwent the Octopus procedure over the study period. Mean TAAA diameter was 6.7cm, with 14% dissection related and 86% degenerative TAAA. All patients had been turned down for open repair and three (14%) were done urgently of which two were ruptures. TAAA extent was 9% type 2, 62% type 3, 29% type 4. A mean of 3.04 branches were revascularized per patient, with the SMA (90%) perfused through its own limb, and both renals usually reconstructed in parallel graft fashion (left 90%, right 85.7%) with the distal abdominal extension though one of the limbs. Mean operative time was 8 hours, fluoroscopy time 164 minutes, contrast 182mL, and blood loss 807mL. We staged the thoracic and juxtavisceral portions of the cases in 24% of patients. 90% of cases were able to be completed with exclusion of the TAAA and all planned visceral branches cannulated. Perioperative complications included paraplegia (19%) [13.3% permanent, 26.6% temporary], acute kidney injury (24%), prolonged ventilation (19%), MI (4.9%), and ischemic bowel (4.8%). Median follow up was 13.5 months (range 1-26 months). At latest follow-up, type I endoleak rate was 9.5%, with all being treated with proximal cuffs. Other 2nd interventions included re-stenting of a right renal, angioplasty of an iliac limb kink, and type 2 endoleak coiling. Primary patency of visceral branches was 93.8% at latest follow up (celiac 100%, SMA 94.7%, right renal 88.9%, left renal 94.8%). In-hospital all-cause mortality rate was 14.2%, with 30-day survival being 90.5%, 6-month survival was 88.3%, one year survival 71.4% and 3 year survival was 52.1%.CONCLUSION: The Octopus procedure is a high-risk option for urgent or emergent endovascular TAAA repair with off the shelf devices in patients who are not candidates for open repair.

View details for DOI 10.1016/j.avsg.2019.05.043

View details for PubMedID 31394231