Purpose: The aim of this study was to compare outcomes of single or multistage approach during fenestrated-branched endovascular aortic repair (FB-EVAR) of extensive thoracoabdominal aortic aneurysms (TAAAs). Methods: We reviewed the clinical data of consecutive patients treated by FB-EVAR for Extent I-III TAAAs in 24 centers (2006-2021). All patients received a single brand manufactured patient-specific or off-the-shelf fenestrated-branched stent grafts. Staging strategies included proximal thoracic aortic repair (PTAR), minimally invasive segmental artery coil embolization (MISACE), temporary aneurysm sac perfusion (TASP) and combinations of these techniques. Endpoints were analyzed for elective repair in patients who had single or multistage approach before and after propensity score (PS) adjustment for baseline differences, including the composite 30-day/in-hospital mortality and/or permanent paraplegia, major adverse event (MAE), patient survival and freedom from aortic-related mortality (ARM). Results: A total of 1947 patients (65% male; mean age 71±8 years-old) underwent FB-EVAR of 155 Extent I (10%), 729 Extent II (46%) and 713 Extent III TAAAs (44%). Single stage approach was used in 939 patients (48%) and multistage approach in 1008 patients (52%). Multistage approach was more frequently used in patients undergoing elective compared to non-elective repair (55% vs 35%, P<.001). Staging strategies were PTAR in 743 patients (74%), TASP in 128 (13%), MISACE in 10 (1%) and combinations in 127 (12%). Among patients undergoing elective repair (n=1597), the composite endpoint of 30-day/in-hospital mortality and/or permanent paraplegia rate occurred in 14% of single stage and 6% of multistage approach patients (P<.001). After adjustment with a PS, multistage approach was associated with lower rates of 30-day/in-hospital mortality and/or permanent paraplegia (Odds Ratio (OR), 0.466; 95% Confidence Interval [CI], 0.271-0.801, P = .006) and higher patient survival at 1 year (86.9±1.3% vs 79.6±1.7%) and 3 years (72.7±2.1% vs 64.2±2.3%, adjusted Hazard Ratio [aHR], 0.714; 95% CI, 0.528 -0.966; P = .029), compared to a single stage approach. Conclusion: Staging elective FB-EVAR of Extent I to III TAAAs was associated with decreased risk of mortality and/or permanent paraplegia at 30-days or within hospital stay, and with higher patient survival at 1- and 3-years.
Dias-Neto, M., Tenorio, E.R., Huang, Y., Jakimowicz, T., Mendes, B.C., Kolbel, T., et al. (2023). Comparison of single and multistage strategies during fenestrated-branched endovascular aortic repair of thoracoabdominal aortic aneurysms. JOURNAL OF VASCULAR SURGERY, -, 3-39 [10.1016/j.jvs.2023.01.188].
Comparison of single and multistage strategies during fenestrated-branched endovascular aortic repair of thoracoabdominal aortic aneurysms
Gargiulo, Mauro;Varcica, Andrea;Gallitto, Enrico;Faggioli, Gianluca;
2023
Abstract
Purpose: The aim of this study was to compare outcomes of single or multistage approach during fenestrated-branched endovascular aortic repair (FB-EVAR) of extensive thoracoabdominal aortic aneurysms (TAAAs). Methods: We reviewed the clinical data of consecutive patients treated by FB-EVAR for Extent I-III TAAAs in 24 centers (2006-2021). All patients received a single brand manufactured patient-specific or off-the-shelf fenestrated-branched stent grafts. Staging strategies included proximal thoracic aortic repair (PTAR), minimally invasive segmental artery coil embolization (MISACE), temporary aneurysm sac perfusion (TASP) and combinations of these techniques. Endpoints were analyzed for elective repair in patients who had single or multistage approach before and after propensity score (PS) adjustment for baseline differences, including the composite 30-day/in-hospital mortality and/or permanent paraplegia, major adverse event (MAE), patient survival and freedom from aortic-related mortality (ARM). Results: A total of 1947 patients (65% male; mean age 71±8 years-old) underwent FB-EVAR of 155 Extent I (10%), 729 Extent II (46%) and 713 Extent III TAAAs (44%). Single stage approach was used in 939 patients (48%) and multistage approach in 1008 patients (52%). Multistage approach was more frequently used in patients undergoing elective compared to non-elective repair (55% vs 35%, P<.001). Staging strategies were PTAR in 743 patients (74%), TASP in 128 (13%), MISACE in 10 (1%) and combinations in 127 (12%). Among patients undergoing elective repair (n=1597), the composite endpoint of 30-day/in-hospital mortality and/or permanent paraplegia rate occurred in 14% of single stage and 6% of multistage approach patients (P<.001). After adjustment with a PS, multistage approach was associated with lower rates of 30-day/in-hospital mortality and/or permanent paraplegia (Odds Ratio (OR), 0.466; 95% Confidence Interval [CI], 0.271-0.801, P = .006) and higher patient survival at 1 year (86.9±1.3% vs 79.6±1.7%) and 3 years (72.7±2.1% vs 64.2±2.3%, adjusted Hazard Ratio [aHR], 0.714; 95% CI, 0.528 -0.966; P = .029), compared to a single stage approach. Conclusion: Staging elective FB-EVAR of Extent I to III TAAAs was associated with decreased risk of mortality and/or permanent paraplegia at 30-days or within hospital stay, and with higher patient survival at 1- and 3-years.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
