Italian COLT Registry: A Multicenter Experience

Objective: The objective was to evaluate early and midterm results of elective and urgent endovascular treatment of complex thoracoabdomi- nal aortic diseases with the custom-made multibranched COLT endog- raft system (JOTEC, Hechingen, Germany). Methods: Thirteen patients (12 men and 1 woman; mean age, 72 years) were treated with the custom-made multibranched COLT endograft sys- tem from June 2018 to December 2019 in three different Italian institu- tions. The complex thoracoabdominal aortic diseases were divided as follows: 3 ruptured post-dissection aneurysms; 10 thoracoabdominal aortic aneurysms. One patient was treated for an impending rupture af- ter an endoprosthesis migration. All patients were assigned to American Society of Anesthesiologists class 3 or class 4. The median aneurysm diameter was 74 mm. All procedures were performed under general anesthesia, with femoral and axillary percutaneous approach. The spinal catheter for cerebrospinal fluid drainage was used in all the elective cases. Emergent and urgent procedures were completed in one step; all the others were divided in two stages. Self-expanding covered stents were implanted as bridging stent grafts to connect the target visceral vessels (TVVs) with the main body. Balloon-expandable covered stents were used to fix the bridging stent proximally, and distal relining with bare self-expandable metal stents was employed to provide a good land- ing zone when a tortuous anatomy was present. The technical success was defined as the absence of type I and type III endoleak at the end of the procedure and patency of all TVVs. The presence of spinal cord ischemia, procedure-related reinterventions, presence of any type ofendoleak, freedom from reinterventions, overall survival, and 30-day mor- tality were also evaluated. Results: Technical success was achieved in 85% of procedures; 52 TVVs were involved, and 2 TVVs (1 celiac trunk and 1 right renal artery) were embolized in urgent settings. No cases of spinal cord ischemia or aorta- related mortality were recorded. We registered two early deaths, one on postoperative day 6 and the other after 10 days due to myocardial infarction. Two late deaths, after 2 months and 4 months, were related to cerebral hemorrhage and pneumonia. The mean follow-up was 6 months. No type I or type III endoleaks and no bridge stent occlusion were recorded. Freedom from reinterventions was 100%. The estimated survival rate was 79.1%. Conclusions: The use of the COLT stent graft in thoracoabdominal dis- ease appears to be feasible and safe in elective and urgent settings. The use of self-expanding covered stents as bridging stent grafts, combined with a proximal fixing with balloon-expandable covered stents and a se- lective distal relining, seems to provide good early and midterm results. Long-term follow-up is necessary to confirm these results