Three-Vessel Fenestrated Repair of 6-cm Thoracoabdominal Aortic Aneurysm After a Chronic Type B Dissection

Abstract

TAAAs. The majority of repairs used company-manufactured, custommade devices (n ¼ 248 [81%]). Between groups, no perioperative differences were observed in myocardial infarction, stroke, acute kidney injury, dialysis, target artery occlusion, access site complication, or type I or type III endoleak (all P > .05). Perioperative paraparesis was higher in the extensive TAAA group (7.8% vs 0.5%; P ¼ .001), but paralysis was equivalent (2.2% vs 0.5%; P ¼ .21). On Kaplan-Meier analysis, no differences in survival, target artery patency, or freedom from reintervention were observed at 3 years (all P > .05). Freedom from type I or type III endoleak (P < .01) and branch instability (P < .01) was significantly lower in the extensive TAAA group. Cox proportional hazards modeling demonstrated that TAAA extent was not independently associated with survival (hazard ratio, 1.79; 95% confidence interval, 0.91-3.53; P ¼ .09).Conclusions: Unlike open TAAA repair, F/B-EVAR for extensive TAAAs is not associated with markedly inferior outcomes. Differences are likely to be accounted for by the increasing length of aortic coverage and number of target arteries involved. These findings suggest that high-volume centers performing F/B-EVAR for nonextensive TAAA should be able to maintain similar outcomes as an increasing number of extensive TAAA repairs are performed.