Midterm Outcomes Following Endovascular Repair of Complex Aortic Aneurysms in Patients with Connective Tissue Disorders

P0216 

Abstract Submission 

Lucas Ribe (1), Yuki Ikeno (1), Safa Savadi (2), Rana Afifi (3), Akiko Tanaka (4), Lucas Ruiter (5), Gustavo Oderich (1)

(1) McGovern Medical School at UTHealth, Houston, TX, (2) McGovern Medical School UTHealth, HOUSTON, TX, (3) Memorial Hermann, Houston, TX, (4) Memorial Hermann Heart and Vascular Institute, Houston, TX, (5) McGovern Medical School UTHealth, Houston, TX

Lucas Ribe    -  Contact Me
McGovern Medical School at UTHealth

Yuki Ikeno    -  Contact Me
McGovern Medical School at UTHealth

Safa Savadi    -  Contact Me
McGovern Medical School UTHealth

Rana Afifi    -  Contact Me
Memorial Hermann

Akiko Tanaka    -  Contact Me
Memorial Hermann Heart and Vascular Institute

Lucas Ruiter Kanamori    -  Contact Me
McGovern Medical School UTHealth

Gustavo Oderich    -  Contact Me
McGovern Medical School at UTHealth

Lucas Ribe    -  Contact Me
McGovern Medical School at UTHealth

Objective

The purpose of this study was to describe mid-term surgical outcomes in patients with thoraco-abdominal aortic aneurysms or dissections after complex endovascular procedures. Connective tissue disorders (CTDs) represent a unique group of patients with special features and medical problems. We conducted a retrospective review of our experience with complex endovascular aortic repair of thoracoabdominal aortic aneurysms (TAAAs) and dissections in patients with CTDs to evaluate complications and midterm outcomes.

Methods

Data were analysed by univariate methods, including contingency tables and logistic regression. Complications analysed included cardiovascular, stroke, renal, respiratory, gastrointestinal, and 30-day mortality.

Results

We conducted a review of 12 patients who underwent endovascular repair for confirmed connective tissue disorders (CTDs) and thoracoabdominal aortic aneurysms or dissections between 2018 and 2023. 10 patients were treated with Fenestrated-branched endovascular repair (FB-EVAR), and 2 with physician modified endovascular graft (PMEG). The median age was 72 years (IQR 63-81), with 5 females (42%) among them. Among these patients, six had previously been diagnosed with Marfan syndrome (50%), four had confirmed Loeys-Dietz syndrome (LDS) (33.3%), one (8.3%) had Ehlers-Danlos Syndrome (EDS), and one patient was diagnosed with an ACTA 2 mutation (8.3%).
Additionally, 11 patients (92%) had previously undergone open aortic surgery before the complex endovascular repair, and 9 patients (75%) had previously undergone some endovascular aortic procedures. Nine (75%) were treated for aortic dissections, and eleven (92%) for aortic aneurysmal disease. Four patients (33%) required re-intervention, and four patients (33%) had endoleaks, with 2 requiring intervention.

Conclusions

This study found that patients with CTDs undergoing complex FB-EVAR in complex aortic repairs had a low perioperative mortality rate, and elevated rate of early technical success. Mid-term survival may be similar to those previous publications of CTD patients following thoracoabdominal open repairs.

Descending/Thoracoabdominal Aorta