Postoperative Outcomes and Reinterventions Following Fenestrated/Branched Endovascular Aortic Repair in Post-Dissection and Complex Degenerative Abdominal and Thoraco-Abdominal Aortic Aneurysms

Abstract

Background: The outcome of FBEVAR in post-dissection thoracoabdominal aortic aneurysms has not been well established in the literature. The aim of this study was to compare midterm outcomes following FBEVAR in post-dissection aneurysms to degenerative aneurysms. (2) Methods: This was a retrospective review of all patients undergoing FBEVAR in a single center between 2017 and 2020. The baseline characteristics, intraoperative details, and postoperative outcomes of patients with post-dissection aneurysms were compared to those with degenerative outcomes. The primary end point was unplanned reinterventions. Cox regression analysis was performed to identify the determinants of worse outcomes. Results: A total of 137 subjects with a mean age of 70 ± 10 years were included in the study, out of which 30 presented post-dissection aneurysms (22%). Custom-made devices were employed in 119 patients, off-the-shelf devices in 13 and physician-modified endografts in 5, with incorporation in 505 target vessels. The technical success rate was comparable in both groups (97% vs. 98%, p = 0.21). However, the one-year freedom from unplanned reintervention was lower in the post-dissection group (67% vs. 89%, p = 0.011). Conclusion: FBEVAR in post-dissection aneurysms is associated with a favorable technical success rate, but reintervention rates remain high. Long procedural duration and the use of adjunctive techniques are associated with increased risk of reinterventions.

A Systematic Review and an Updated Meta-Analysis of Fenestrated/Branched Endovascular Aortic Repair of Chronic Post-Dissection Thoracoabdominal Aortic Aneurysms

“…Of these, 203 were excluded for one or more of the following reasons: provided data on aortic arch disease (n = 21); reported on open or hybrid repair (n = 17); provided data on Mesh Stent (n = 1); case reports, technical notes or case series with >10 patients (n = 18); editorial and review articles (n = 6); provided mixed data on TAAs and TAAAs (n = 14); provided mixed data on degenerative TAAAs and PDTAAAs (n = 51); were irrelevant (n = 61); and/or reported on overlapping patient populations (n = 14) (Figure 1). Finally, 10 studies [32][33][34][35][36][37][38][39][40][41], with a total of 585 patients (1255.65 p-ys), were deemed eligible for inclusion in the meta-analysis (Table 1) (Figure 1). CMD: custom-made device; PMSG: physician-modified stent graft.…”

“…Regarding target vessels (TVs), data were provided in eight studies [32][33][34][35][37][38][39][40], with a total of 1815 vessels being incorporated in the repairs with either a fenestration, branch or a scallop. Four studies [33][34][35]40] describing 143 patients with 521 TVs reported a rate of need for perforation of the dissection flap of 3.6% (19/521).…”

“…In one patient treated with a PMSG, CT and SMA were inadvertently cannulated through the same limb and CT was sacrificed [33]. In three further patients, the reason for technical failure was not described [35,37].…”

“…TV patency data were provided in eight studies [33][34][35][36][37][38][39][40] for 12 months with a pooled estimate of 97.6% (95% CI 94.9% to 98.8%, I 2 = 0%) (Supplementary Figure S12) and in five studies [35,36,[38][39][40] for 24 months with a pooled rate of 96.7% (95% CI 93.5% to 98.3%, I 2 = 0%) (Supplementary Figure S13). The 36-month TV patency was estimated at 94.3% (95% CI 91.8% to 96.1%, I 2 = 0%) (Supplementary Figure S14) among six eligible studies [32,35,36,[38][39][40].…”

“…Freedom from reintervention was estimated at 83.9% (95% CI 75.9% to 89.6%, I 2 = 71%) for 12 months [32][33][34][35][36][37][38][39][40], 82.8% (95% CI 68.7% to 91.4%, I 2 = 87.8%) for 24 months [32,35,36,[38][39][40] and 76.1% (95% CI 60.6% to 86.8%, I 2 = 87.4%) for 36 months [32,35,36,39,40] (Supplementary Figures S15-S17).…”