Multicenter trans-Atlantic experience with fenestrated-branched endovascular aortic repair of chronic post-dissection thoracoabdominal aortic aneurysms
Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved..
OBJECTIVE: This multicenter international study aimed to describe outcomes of fenestrated-branched endovascular aortic repairs (FB-EVAR) in a cohort of patients treated for chronic post-dissection thoracoabdominal aortic aneurysms (PD-TAAAs).
METHODS: We reviewed the clinical data of all consecutive patients treated by FB-EVAR for repair of extent I to III PD-TAAAs in 16 centers from the United States and Europe (2008-2021). Data were extracted from institutional prospectively maintained databases and electronic patient records. All patients received off-the-shelf or patient-specific manufactured fenestrated-branched stent grafts. Endpoints were any cause mortality and major adverse events at 30 days, technical success, target artery (TA) patency, freedom from TA instability, minor (endovascular with <12 Fr sheath) and major (open or ≥12 Fr sheath) secondary interventions, patient survival, and freedom from aortic-related mortality (ARM).
RESULTS: A total of 246 patients (76% male; median age, 67 years [interquartile range, 61-73 years]) were treated for extent I (7%), extent II (55%), and extent III (35%) PD-TAAAs by FB-EVAR. The median aneurysm diameter was 65 mm (interquartile range, 59-73 mm). Eighteen patients (7%) were octogenarians, 212 (86%) were American Society of Anesthesiologists class ≥3, and 21 (9%) presented with contained ruptured or symptomatic aneurysms. There were 917 renal-mesenteric vessels targeted by 581 fenestrations (63%) and 336 directional branches (37%), with a mean of 3.7 vessels per patient. Technical success was 96%. Mortality and rate of major adverse events at 30 days was 3% and 28%, including disabling complications such as new onset dialysis in 1%, major stroke in 1%, and permanent paraplegia in 2%. Mean follow-up was 24 months. Kaplan-Meier (KM) estimated patient survival at 3 and 5 years was 79% ± 6% and 65% ± 10%. KM estimated freedom from ARM was 95% ± 3% and 93% ± 5% at the same intervals. Unplanned secondary interventions were needed in 94 patients (38%), including minor procedures in 64 (25%) and major procedures in 30 (12%). There was one conversion to open surgical repair (<1%). KM estimated freedom from any secondary intervention was 44% ± 9% at 5 years. KM estimated primary and secondary TA patency were 93% ± 2% and 96% ± 1% at 5 years, respectively.
CONCLUSIONS: FB-EVAR for chronic PD-TAAAs was associated with high technical success and a low rate of mortality (3%) and disabling complications at 30 days. Although the procedure is effective in the prevention of ARM, patient survival was low at 5 years (65%), likely due to the significant comorbidities in this cohort of patients. Freedom from secondary interventions at 5 years was 44%, although most procedures were minor. The significant rate of reinterventions highlights the need for continued patient surveillance.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:78 |
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| Enthalten in: |
Journal of vascular surgery - 78(2023), 4 vom: 16. Okt., Seite 854-862.e1 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Abdelhalim, Mohamed A [VerfasserIn] |
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| Links: |
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| Themen: |
Aortic dissection |
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| Anmerkungen: |
Date Completed 29.09.2023 Date Revised 20.03.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.jvs.2023.05.053 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM358231175 |
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| 100 | 1 | |a Abdelhalim, Mohamed A |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Multicenter trans-Atlantic experience with fenestrated-branched endovascular aortic repair of chronic post-dissection thoracoabdominal aortic aneurysms |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Completed 29.09.2023 | ||
| 500 | |a Date Revised 20.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a OBJECTIVE: This multicenter international study aimed to describe outcomes of fenestrated-branched endovascular aortic repairs (FB-EVAR) in a cohort of patients treated for chronic post-dissection thoracoabdominal aortic aneurysms (PD-TAAAs) | ||
| 520 | |a METHODS: We reviewed the clinical data of all consecutive patients treated by FB-EVAR for repair of extent I to III PD-TAAAs in 16 centers from the United States and Europe (2008-2021). Data were extracted from institutional prospectively maintained databases and electronic patient records. All patients received off-the-shelf or patient-specific manufactured fenestrated-branched stent grafts. Endpoints were any cause mortality and major adverse events at 30 days, technical success, target artery (TA) patency, freedom from TA instability, minor (endovascular with <12 Fr sheath) and major (open or ≥12 Fr sheath) secondary interventions, patient survival, and freedom from aortic-related mortality (ARM) | ||
| 520 | |a RESULTS: A total of 246 patients (76% male; median age, 67 years [interquartile range, 61-73 years]) were treated for extent I (7%), extent II (55%), and extent III (35%) PD-TAAAs by FB-EVAR. The median aneurysm diameter was 65 mm (interquartile range, 59-73 mm). Eighteen patients (7%) were octogenarians, 212 (86%) were American Society of Anesthesiologists class ≥3, and 21 (9%) presented with contained ruptured or symptomatic aneurysms. There were 917 renal-mesenteric vessels targeted by 581 fenestrations (63%) and 336 directional branches (37%), with a mean of 3.7 vessels per patient. Technical success was 96%. Mortality and rate of major adverse events at 30 days was 3% and 28%, including disabling complications such as new onset dialysis in 1%, major stroke in 1%, and permanent paraplegia in 2%. Mean follow-up was 24 months. Kaplan-Meier (KM) estimated patient survival at 3 and 5 years was 79% ± 6% and 65% ± 10%. KM estimated freedom from ARM was 95% ± 3% and 93% ± 5% at the same intervals. Unplanned secondary interventions were needed in 94 patients (38%), including minor procedures in 64 (25%) and major procedures in 30 (12%). There was one conversion to open surgical repair (<1%). KM estimated freedom from any secondary intervention was 44% ± 9% at 5 years. KM estimated primary and secondary TA patency were 93% ± 2% and 96% ± 1% at 5 years, respectively | ||
| 520 | |a CONCLUSIONS: FB-EVAR for chronic PD-TAAAs was associated with high technical success and a low rate of mortality (3%) and disabling complications at 30 days. Although the procedure is effective in the prevention of ARM, patient survival was low at 5 years (65%), likely due to the significant comorbidities in this cohort of patients. Freedom from secondary interventions at 5 years was 44%, although most procedures were minor. The significant rate of reinterventions highlights the need for continued patient surveillance | ||
| 650 | 4 | |a Journal Article | |
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| 650 | 4 | |a Aortic dissection | |
| 650 | 4 | |a BEVAR | |
| 650 | 4 | |a Branched | |
| 650 | 4 | |a FEVAR | |
| 650 | 4 | |a Fenestrated | |
| 650 | 4 | |a Thoracoabdominal aortic aneurysm | |
| 700 | 1 | |a Tenorio, Emanuel R |e verfasserin |4 aut | |
| 700 | 1 | |a Oderich, Gustavo S |e verfasserin |4 aut | |
| 700 | 1 | |a Haulon, Stephan |e verfasserin |4 aut | |
| 700 | 1 | |a Warren, Gasper |e verfasserin |4 aut | |
| 700 | 1 | |a Adam, Donald |e verfasserin |4 aut | |
| 700 | 1 | |a Claridge, Martin |e verfasserin |4 aut | |
| 700 | 1 | |a Butt, Talha |e verfasserin |4 aut | |
| 700 | 1 | |a Abisi, Said |e verfasserin |4 aut | |
| 700 | 1 | |a Dias, Nuno V |e verfasserin |4 aut | |
| 700 | 1 | |a Kölbel, Tilo |e verfasserin |4 aut | |
| 700 | 1 | |a Gallitto, Enrico |e verfasserin |4 aut | |
| 700 | 1 | |a Gargiulo, Mauro |e verfasserin |4 aut | |
| 700 | 1 | |a Gkoutzios, Panos |e verfasserin |4 aut | |
| 700 | 1 | |a Panuccio, Giuseppe |e verfasserin |4 aut | |
| 700 | 1 | |a Kuzniar, Marek |e verfasserin |4 aut | |
| 700 | 1 | |a Mani, Kevin |e verfasserin |4 aut | |
| 700 | 1 | |a Mees, Barend M |e verfasserin |4 aut | |
| 700 | 1 | |a Schurink, Geert W |e verfasserin |4 aut | |
| 700 | 1 | |a Sonesson, Björn |e verfasserin |4 aut | |
| 700 | 1 | |a Spath, Paolo |e verfasserin |4 aut | |
| 700 | 1 | |a Wanhainen, Anders |e verfasserin |4 aut | |
| 700 | 1 | |a Schanzer, Andres |e verfasserin |4 aut | |
| 700 | 1 | |a Beck, Adam W |e verfasserin |4 aut | |
| 700 | 1 | |a Schneider, Darren B |e verfasserin |4 aut | |
| 700 | 1 | |a Timaran, Carlos H |e verfasserin |4 aut | |
| 700 | 1 | |a Eagleton, Matthew |e verfasserin |4 aut | |
| 700 | 1 | |a Farber, Mark A |e verfasserin |4 aut | |
| 700 | 1 | |a Modarai, Bijan |e verfasserin |4 aut | |
| 700 | 0 | |a Multicenter International Aortic Research Group |e verfasserin |4 aut | |
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