P216. Midterm Outcomes Following Endovascular Repair of Complex Aortic Aneurysms in Patients with Connective Tissue Disorders
McGovern Medical School at UTHealth
Houston, TX
United States - Contact Me
Avanced Aortic Surgery Fellow at Memorial Hermann Hospital, Houston.
I currently live in Houston, where I am completing a two- year Fellowship in advanced aortic surgery. I am greatly engaged in open surgery for aortic aneurysms and dissections, as well as in modern vascular surgery, with large interest in vascular innovations, latest technology in vascular and aortic endovascular surgery, and greatly interested in medical and academic education, as well as surgical simulation.
I previously joined La Fe University Hospital in 2014 as a junior physician in angiology and vascular surgery, within the department of vascular surgery.
Prior to La Fe, I was the first Spanish junior vascular surgeon to complete a senior clinical Fellowship in aortic surgery at St. Mary’s Hospital, Imperial College of London, during an 18- month period,
and one of the first Spanish surgeons to become an official fellow of the European board of vascular and endovascular surgery (FEBVS).
Prior to this experience, I completed my residency in vascular surgery at Gregorio Marañón University hospital in Madrid, during a five- year period.
During my tenure in Madrid, I helped the hospital with the medical and residents training program, and participated in several national and international simulation courses, workshops, and meetings.
I am a graduate of the University of Alcala in Madrid, where I majored my bachelor in medicine.
Description
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.
Authors
Lucas Ribe (1), Yuki Ikeno (1), Safa Savadi (2), Rana Afifi (3), Akiko Tanaka (4), Lucas Ruiter (5), Gustavo Oderich (1)
Institutions
(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