Citations 2
Outcomes of Elective and Non-elective Fenestrated-branched Endovascular Aortic Repair for Treatment of Thoracoabdominal Aortic Aneurysms
Dias‐Neto, Marina , Vacirca, Andrea , Huang, Ying , Baghbani‐Oskouei, Aidin , Jakimowicz, Tomasz , Mendes, Bernardo C. , Bertoglio, Luca , Gargiulo, Mauro , Dias, Nuno , Schanzer, Andres , Gasper, Warren J. , Mani, Kevin , Timaran, Carlos H. , Schneider, Darren B. , Pedro, Luís Mendes , Tsilimparis, Nikolaos , Sweet, Matthew P. , Eagleton, Matthew J. , Khashram, Manar, Jama, Katarzyna , Panuccio, Giuseppe , Rohlffs, Fiona, Chiesa, Roberto , Kahlberg, Andrea , Schurink, Geert Willem H. , Lemmens, Charlotte , Karelis, Angelos , Parodi, Ezequiel, Habib, Mohammed , Cólon, Jesus Porras, Pavarino, Felipe, Baig, Mirza S. , Crawford, Sean A. , Garcia, Rita , Ribeiro, Tiago , Alves, Gonçalo, Gonçalves, Frederico Bastos , Kappe, Kaj O. , Knippenberg, Samira Elize Mariko van , Tran, Bich L. , Gormley, Sinead , Oderich, Gustavo S. , Baghbani, Aidin , Panuccio, Giuseppe , Dias-Neto, Marina , Schneider, Darren B , Kölbel, Tilo , Sobocinski, Jonathan , Mees, Barend M.E. , Dias, Nuno , Beck, Adam W , Farber, Mark , Haulon, Stéphan , Ferreira, Emília, Yeung, Kak Khee , Khashram, Manar , Rohlffs, Fiona , Mésnard, Thomas , Gallitto, Enrico , Faggioli, Gianluca , Gomes, Vivian Carla , Wanhainen, Anders , Habib, Mohammed, Colon, Jesus Porras, Baig, Mirza S., Melo, Ryan Gouveia e , Zettervall, Sara L , Oderich, Gustavo S.
Annals of Surgery | July 3, 2023 | Volume: 278 | Issue: 4 | Pages: 568-577
Objective: To describe outcomes after elective and non-elective fenestrated-branched endovascular aortic repair (FB-EVAR) for thoracoabdominal aortic aneurysms (TAAAs). Background: FB-EVAR has been increasingly utilized to treat TAAAs; however, outcomes after non-elective versus elective repair are not well described. Methods: Clinical data of consecutive patients undergoing FB-EVAR for TAAAs at 24 centers (2006–2021) were reviewed. Endpoints including early mortality and major adverse events (MAEs), all-cause mortality, and aortic-related mortality (ARM), were analyzed and compared in patients who had non-elective versus elective repair. Results: A total of 2603 patients (69% males; mean age 72±10 year old) underwent FB-EVAR for TAAAs. Elective repair was performed in 2187 patients (84%) and non-elective repair in 416 patients [16%; 268 (64%) symptomatic, 148 (36%) ruptured]. Non-elective FB-EVAR was associated with higher early mortality (17% vs 5%, P<0.001) and rates of MAEs (34% vs 20%, P<0.001). Median follow-up was 15 months (interquartile range, 7–37 months). Survival and cumulative incidence of ARM at 3 years were both lower for non-elective versus elective patients (50±4% vs 70±1% and 21±3% vs 7±1%, P<0.001). On multivariable analysis, non-elective repair was associated with increased risk of all-cause mortality (hazard ratio, 1.92; 95% CI] 1.50–2.44; P<0.001) and ARM (hazard ratio, 2.43; 95% CI, 1.63–3.62; P<0.001). Conclusions: Non-elective FB-EVAR of symptomatic or ruptured TAAAs is feasible, but carries higher incidence of early MAEs and increased all-cause mortality and ARM than elective repair. Long-term follow-up is warranted to justify the treatment.
Multicenter Study to Evaluate Endovascular Repair of Extent I-III Thoracoabdominal Aneurysms Without Prophylactic Cerebrospinal Fluid Drainage
Tenorio, Emanuel R. , Adam, Donald J., Timaran, Carlos H. , Austermann, Martin , Bertoglio, Luca , Jakimowicz, Tomasz , Scott, Carla K. , Berekoven, Bärbel, Chiesa, Roberto , Lima, Guilherme Baumgardt Barbosa , Jama, Katarzyna , Squizzato, Francesco , Claridge, Martin, Mendes, Bernardo C. , Oderich, Gustavo S. , Cirillo-Penn, Nolan C. , Tenorio, Emanuel R , Lima, Guilherme B , Marcondes, Giulianna B. , Piazza, Michele , Juszczak, Maciej , Oderich, Gustavo S.
Annals of Surgery | August 5, 2022 | Volume: 278 | Issue: 2 | Pages: e396-e404
Objective: To assess outcomes of fenestrated-branched endovascular aortic repair (FB-EVAR) of Extent I-III thoracoabdominal aortic aneurysms (TAAAs) without prophylactic cerebrospinal fluid drainage (CSFD). Background: Prophylactic CSFD has been routinely used during endovascular TAAA repair, but concerns about major drain-related complications have led to revising this paradigm. Methods: We reviewed a multicenter cohort of 541 patients treated for Extent I-III TAAAs by FB-EVAR without prophylactic CSFD. Spinal cord injury (SCI) was graded as ambulatory (paraparesis) or nonambulatory (paraplegia). Endpoints were any SCI, permanent paraplegia, response to rescue treatment, major drain-related complications, mortality, and patient survival. Results: There were 22 Extent I, 240 Extent II and 279 Extent III TAAAs. Thirty-day mortality was 3%. SCI occurred in 45 patients (8%), paraparesis occurring in 23 (4%) and paraplegia in 22 patients (4%). SCI was more common in patients with Extent I-II compared with Extent III TAAAs (12% vs. 5%, P=0.01). Rescue treatment included permissive hypertension in all patients, with CSFD in 22 (4%). Symptom improvement was noted in 73%. Twelve patients (2%) had permanent paraplegia. Two patients (0.4%) had major drain-related complications. Independent predictors for SCI by multivariate logistic regression were sustained perioperative hypotension [odds ratio (OR): 4.4, 95% confidence interval (95% CI): 1.7–11.1], patent collateral network (OR: 0.3, 95% CI: 0.1–0.6), and total length of aortic coverage (OR: 1.05, 95% CI: 1.01–1.10). Patient survival at 3 years was 72%±3%. Conclusion: FB-EVAR of Extent I-III TAAAs without CSFD has low mortality and low rates of permanent paraplegia (2%). SCI occurred in 8% of patients, and rescue treatment improved symptoms in 73% of them.