Citations 1
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.