Long-term outcomes of the Physician-Modified Fenestrated and Branched Endovascular Grafts for Complex Aortic Disease

P0199 

Abstract Submission 

Guangmin Yang (1), min zhou (2)

(1) N/A, N/A, (2) N/A, jiangsu, China

Guangmin Yang    -  Contact Me
N/A

min zhou    -  Contact Me
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Guangmin Yang    -  Contact Me
N/A

Objective
Although physician-modified fenestrated and branched endografts (PMEGs) has been proposed as an alternative endovascular solution for complex aortic aneurysm for decades, its usage is still limited by lack of long-term data in large series. This report marks the first comprehensive analysis focusing on the long-term outcomes of PMEGs in the endovascular repair of complex aortic diseases, drawing data from three aortic centers in southeast China.
Materials and methods Between 2017 and 2021, patients undergoing PMEGs in 3 southeast China academic centers were collected. Data of patients with PMEGs were retrospectively analyzed. Perioperative morbidity/mortality was assessed as early outcomes. Survival, freedom from reintervention (FFRs), and target vessels (TVs) patency and freedom from any instability were assessed as late follow-up outcomes.
Results Among 186 patients who underwent PMEGs for complex aortic disease (156 males; mean age 68.4±13.4 years), 151(81.2%) had extent thoracoabdominal aortic aneurysm (TAAAs) and 35 (18.8%) had complex abdominal aortic aneurysm (CAAAs, defined as short neck infrarenal, juxtarenal, and pararenal AAAs). A total of 618 TVs were incorporated by fenestrations or branches (3.3±0.9 vessel/patient). 89 patients with TAAAs had incidence of prior aortic repair, including thoracic EVAR (TEVAR, 41.0%), frozen elephant trunk (FET, 9.9%) or FET plus TEVAR (6.6%) procedures. 30-day or in hospital mortality occurred in 6 patients (3.2%). Morbidities included acute kidney injury in 11 (5.9%); new-onset dialysis in 6 (3.2%); and stroke, myocardial infarction, and limb ischemia in 5 (2.7%) patients each; respiratory failure requiring treatment in 7 (3.8%) patients, and bowel ischemia requiring resection in 3 (1.6%). Only one patient developed spinal cord injury with transient paresthesia. Independent predictors for all-cause mortality by multivariate cox regression analysis were age (+1 year, HR:1.104, 95% CI: 1.013 -1.203; p= .024), total operative time (HR:1.018, 95% CI: 1.010 -1.027; p≤ .001), largest aortic diameter (HR: 1.046, 95% CI: 1.006 -1.087; p= .025). After a mean follow-up of 3.5 ±1.1 years, there were 4 (2.2%) deaths. In the Kaplan-Meier analysis, the survival rates at 1, 3, and 5 years were 96.2%, 95.1%, and 93.9%, respectively. Freedom from any instability at 1, 3, and 5 years was 97.3% (95% CI, 93.7% - 98.9%), 92.2% (95% CI, 87.2% - 95.3%), and 87.4% (95% CI, 80.3% -92.1%), respectively. The secondary patency for all target vessel at 1, 3 and 5 years was 99.3% (95% CI, 98.4% - 99.7%), 98.5% (95% CI, 97.1% - 99.2%) and 98.5% (95% CI, 97.1% - 99.2%), respectively. Freedom from any reintervention at 1, 3, and 5 years was 96.2% (95% CI, 92.2%-98.2%), 90.4% (95% CI, 85.0%-93.9%) and 72.0% (95% CI, 51.1%-85.2%) for the entire cohort, respectively.
Conclusions FB-EVAR with PMEGs emerges as a safe technique with acceptable postoperative morbidity and mortality rates. PMEGs serve as a crucial bridging tool in the toolkit of aortic surgeons, particularly when manufactured devices are not immediately accessible. Although initial outcomes are promising, pooled data and continued surveillance is a crucial component of endovascular repair. With the continued evolution of endovascular technology, PMEGs stands to benefit from improved standardization of the endovascular procedure, with the hope of broader adoption in the f

Descending/Thoracoabdominal Aorta