Initial experience with the E-ventus® stent-graft for endovascular treatment of visceral artery aneurysms

BACKGROUND: To evaluate the safety and efficacy of a novel balloon-expandable stent-graft for endovascular treatment of visceral artery aneurysms (VAA). METHODS: Between 9/2014 and 1/2017 seven patients (69±15 years) with true (N.=4) and false (N.=3) VAAs were treated by implantation of balloon-expandable stent-grafts (E-ventus®, Jotec, Hechingen, Germany) using a transfemoral (N.=2) or transbrachial (N.=5) vascular access. The stent-graft was placed without prior passing of the landing zone with a sheath. In 3 of 7 patients (42.9%) additional coil or plug embolization was performed to prevent retrograde VAA perfusion. Endpoints were technical success (defined as delivery and implantation of the stent-graft in the intended position with complete exclusion of the VAA), peri-procedural complications and patency. RESULTS: Mean diameters of true VAAs (splenic artery: N.=2, common hepatic artery: N.=1, celiac trunk: N.=1) were 26±9 and of false (common hepatic artery: N.=2, gastroduodenal artery: N.=1) 29±14 mm. False aneurysms presented as emergencies with active bleeding. Technical success was 100%. One peri-procedural complication was noted: pseudoaneurysm of the accessed brachial artery. After a mean follow-up of 187 days 6/7 stent-grafts (85.7%) were patent. One patient (fVAA) died two days after the emergency procedure owing to multi-organ failure which was assessed to be non-procedure-related. Another patient (fVAA) died 7 months from the procedure owing to cancer. CONCLUSIONS: Endovascular treatment of true and false visceral artery aneurysms by use of the E-ventus® stent-graft is safe and effective. Flexibility of the stent-graft and shaft allows for implantation without passing the lesion with a sheath, enabling treatment of distal as well as complex visceral lesions. Long-Term results regarding patency in a larger patient cohort are needed to confirm these findings.