Outcomes of Elective and Non-elective Fenestrated-branched Endovascular Aortic Repair for Treatment of Thoracoabdominal Aortic Aneurysms

TY - JOUR

T1 - Outcomes of Elective and Non-elective Fenestrated-branched Endovascular Aortic Repair for Treatment of Thoracoabdominal Aortic Aneurysms

AU - Dias-Neto, Marina

AU - Vacirca, Andrea

AU - Huang, Ying

AU - Baghbani-Oskouei, Aidin

AU - Jakimowicz, Tomasz

AU - Mendes, Bernardo C

AU - Kolbel, Tilo

AU - Sobocinski, Jonathan

AU - Bertoglio, Luca

AU - Mees, Barend

AU - Gargiulo, Mauro

AU - Dias, Nuno

AU - Schanzer, Andres

AU - Gasper, Warren

AU - Beck, Adam W

AU - Farber, Mark A

AU - Mani, Kevin

AU - Timaran, Carlos

AU - Schneider, Darren B

AU - Pedro, Luis Mendes

AU - Tsilimparis, Nikolaos

AU - Haulon, Stéphan

AU - Sweet, Matthew P

AU - Ferreira, Emília

AU - Eagleton, Matthew

AU - Yeung, Kak Khee

AU - Khashram, Manar

AU - Jama, Katarzyna

AU - Panuccio, Giuseppe

AU - Rohlffs, Fiona

AU - Mesnard, Thomas

AU - Chiesa, Roberto

AU - Kahlberg, Andrea

AU - Schurink, Geert Willem

AU - Lemmens, Charlotte

AU - Gallitto, Enrico

AU - Faggioli, Gianluca

AU - Karelis, Angelos

AU - Parodi, Ezequiel

AU - Gomes, Vivian

AU - Wanhainen, Anders

AU - Habib, Mohammed

AU - Colon, Jesus Porras

AU - Pavarino, Felipe

AU - Baig, Mirza S

AU - Gouveia E Melo, Ryan Eduardo Costeloe De

AU - Crawford, Sean

AU - Zettervall, Sara L

AU - Garcia, Rita

AU - Ribeiro, Tiago

AU - Alves, Gonçalo

AU - Gonçalves, Frederico Bastos

AU - Kappe, Kaj Olav

AU - Mariko van Knippenberg, Samira Elize

AU - Tran, Bich Lan

AU - Gormley, Sinead

AU - Oderich, Gustavo S

AU - International Multicenter Aortic Research Group

N1 - Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

PY - 2023/10/1

Y1 - 2023/10/1

N2 - OBJECTIVE: To describe outcomes after elective and non-elective fenestrated-branched endovascular aortic repair (FB-EVAR) for thoracoabdominal aortic aneurysms (TAAAs).BACKGROUND: FB-EVAR has been increasingly utilized to treat TAAAs; however, outcomes after non-elective versus elective repair are not well described.METHODS: Clinical data of consecutive patients undergoing FB-EVAR for TAAAs at 24 centers (2006-2021) were reviewed. Endpoints including early mortality and major adverse events (MAEs), all-cause mortality, and aortic-related mortality (ARM), were analyzed and compared in patients who had non-elective versus elective repair.RESULTS: A total of 2603 patients (69% males; mean age 72±10 year old) underwent FB-EVAR for TAAAs. Elective repair was performed in 2187 patients (84%) and non-elective repair in 416 patients [16%; 268 (64%) symptomatic, 148 (36%) ruptured]. Non-elective FB-EVAR was associated with higher early mortality (17% vs 5%, P <0.001) and rates of MAEs (34% vs 20%, P <0.001). Median follow-up was 15 months (interquartile range, 7-37 months). Survival and cumulative incidence of ARM at 3 years were both lower for non-elective versus elective patients (50±4% vs 70±1% and 21±3% vs 7±1%, P <0.001). On multivariable analysis, non-elective repair was associated with increased risk of all-cause mortality (hazard ratio, 1.92; 95% CI] 1.50-2.44; P <0.001) and ARM (hazard ratio, 2.43; 95% CI, 1.63-3.62; P <0.001).CONCLUSIONS: Non-elective FB-EVAR of symptomatic or ruptured TAAAs is feasible, but carries higher incidence of early MAEs and increased all-cause mortality and ARM than elective repair. Long-term follow-up is warranted to justify the treatment.

AB - OBJECTIVE: To describe outcomes after elective and non-elective fenestrated-branched endovascular aortic repair (FB-EVAR) for thoracoabdominal aortic aneurysms (TAAAs).BACKGROUND: FB-EVAR has been increasingly utilized to treat TAAAs; however, outcomes after non-elective versus elective repair are not well described.METHODS: Clinical data of consecutive patients undergoing FB-EVAR for TAAAs at 24 centers (2006-2021) were reviewed. Endpoints including early mortality and major adverse events (MAEs), all-cause mortality, and aortic-related mortality (ARM), were analyzed and compared in patients who had non-elective versus elective repair.RESULTS: A total of 2603 patients (69% males; mean age 72±10 year old) underwent FB-EVAR for TAAAs. Elective repair was performed in 2187 patients (84%) and non-elective repair in 416 patients [16%; 268 (64%) symptomatic, 148 (36%) ruptured]. Non-elective FB-EVAR was associated with higher early mortality (17% vs 5%, P <0.001) and rates of MAEs (34% vs 20%, P <0.001). Median follow-up was 15 months (interquartile range, 7-37 months). Survival and cumulative incidence of ARM at 3 years were both lower for non-elective versus elective patients (50±4% vs 70±1% and 21±3% vs 7±1%, P <0.001). On multivariable analysis, non-elective repair was associated with increased risk of all-cause mortality (hazard ratio, 1.92; 95% CI] 1.50-2.44; P <0.001) and ARM (hazard ratio, 2.43; 95% CI, 1.63-3.62; P <0.001).CONCLUSIONS: Non-elective FB-EVAR of symptomatic or ruptured TAAAs is feasible, but carries higher incidence of early MAEs and increased all-cause mortality and ARM than elective repair. Long-term follow-up is warranted to justify the treatment.

KW - Male

KW - Humans

KW - Middle Aged

KW - Aged

KW - Aged, 80 and over

KW - Female

KW - Aortic Aneurysm, Thoracoabdominal

KW - Aortic Aneurysm, Thoracic/surgery

KW - Aortic Aneurysm, Abdominal/surgery

KW - Endovascular Aneurysm Repair

KW - Blood Vessel Prosthesis Implantation/adverse effects

KW - Treatment Outcome

KW - Risk Factors

KW - Endovascular Procedures/adverse effects

KW - Time Factors

KW - Retrospective Studies

KW - Blood Vessel Prosthesis

U2 - 10.1097/SLA.0000000000005986

DO - 10.1097/SLA.0000000000005986

M3 - SCORING: Journal article

C2 - 37395613

VL - 278

SP - 568

EP - 577

JO - ANN SURG

JF - ANN SURG

SN - 0003-4932

IS - 4

ER -