Citations 2
Multicenter Study on Physician-Modified Endografts for Thoracoabdominal and Complex Abdominal Aortic Aneurysm Repair
Tsilimparis, Nikolaos , Melo, Ryan Gouveia e , Scali, Salvatore T. , Mendes, Bernardo C. , Han, Sukgu M. , Schermerhorn, Marc L. , Adam, Donald J., Malas, Mahmoud B. , Starnes, Benjamin W., Branzan, Daniela , Timaran, Carlos H. , Bertoglio, Luca , Pedro, Luís Mendes , Pyun, Alyssa J., Magee, Gregory A. , Swerdlow, Nicholas J. , Juszczak, Maciej , Patel, Rohini J. , Panuccio, Giuseppe , Sweet, Matthew P. , Becquemin, J.-P. , Canonge, Jennifer , Porras-Colón, Jésus , Giordano, Antonino , Gouveia E Melo, Ryan , Tenorio, Emanuel R , Scali, Salvatore , Mendes, Bernardo, Han, Sukgu , Schermerhorn, Marc , Farber, Mark , Kolbel, Tilo , Joseph, George , Branzan, Daniela , H Timaran, Carlos , Cieri, Enrico , Verzini, Fabio , Beck, Adam W , Chait, Jesse , Pyun, Alyssa , Magee, Gregory A , Juszczak, Maciej , Barleben, Andrew R. , Patel, Rohini , Panuccio, Giuseppe , Sweet, Matthew P , Zettervall, Sara L , Becquemin, Jean-Pierre , Canonge, Jennifer , Porras-Colón, Jésus , Dias-Neto, Marina , Giordano, Antonino , Oderich, Gustavo S , Tenorio, Emanuel R. , Kölbel, Tilo , Cochennec, Frédéric , Gomes, Vivian Carla , Dias‐Neto, Marina , Oderich, Gustavo S.
Circulation | July 11, 2024 | Volume: 150 | Issue: 17 | Pages: 1327-1342
10.1161/circulationaha.123.068587
BACKGROUND: Physician modified endografts (PMEGs) have been widely used in the treatment of complex abdominal aortic aneurysm and thoracoabdominal aortic aneurysm, however, previous data are limited to small single center studies and robust data on safety and effectiveness of PMEGs are lacking. We aimed to perform an international multicenter study analyzing the outcomes of PMEGs in complex abdominal aortic aneurysms and thoracoabdominal aortic aneurysms. METHODS: An international multicenter single-arm cohort study was performed analyzing the outcomes of PMEGs in the treatment of elective, symptomatic, and ruptured complex abdominal aortic aneurysms and thoracoabdominal aortic aneurysms. Variables and outcomes were defined according to the Society for Vascular Surgery reporting standards. Device modification and procedure details were collected and analyzed. Efficacy outcomes included technical success and safety outcomes included major adverse events and 30-day mortality. Follow-up outcomes included reinterventions, endoleaks, target vessel patency rates and overall and aortic-related mortality. Multivariable analysis was performed aiming at identifying predictors of technical success, 30-day mortality, and major adverse events. RESULTS: Overall, 1274 patients were included in the study from 19 centers. Median age was 74 (IQR, 68–79), and 75.7% were men; 45.7% were complex abdominal aortic aneurysms, and 54.3% were thoracoabdominal aortic aneurysms; 65.5% patients presented electively, 24.6% were symptomatic, and 9.9% were ruptured. Most patients (83.1%) were submitted to a fenestrated repair, 3.6% to branched repair, and 13.4% to a combined fenestrated and branched repair. Most patients (85.8%) had ≥3 target vessels included. The overall technical success was 94% (94% in elective, 93.4% in symptomatic, and 95.1% in ruptured cases). Thirty-day mortality was 5.8% (4.1% in elective, 7.6% in symptomatic, and 12.7% in ruptured aneurysms). Major adverse events occurred in 25.2% of cases (23.1% in elective, 27.8% in symptomatic, and 30.3% in ruptured aneurysms). Median follow-up was 21 months (5.6–50.6). Freedom from reintervention was 73.8%, 61.8%, and 51.4% at 1, 3, and 5 years; primary target vessel patency was 96.9%, 93.6%, and 90.3%. Overall survival and freedom from aortic-related mortality was 82.4%/92.9%, 69.9%/91.6%, and 55.0%/89.1% at 1, 3, and 5 years. CONCLUSIONS: PMEGs were a safe and effective treatment option for elective, symptomatic, and ruptured complex aortic aneurysms. Long-term data and future prospective studies are needed for more robust and detailed analysis.
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.