Mid-term outcomes of physician-modified endograft therapy for complex aortic aneurysms

• Published in: Interdisciplinary cardiovascular and thoracic surgery Vol. 38; no. 4
• Main Authors: Shibata, Tsuyoshi, Mitsuoka, Hiroshi, Iba, Yutaka, Hashizume, Kenichi, Hongo, Norio, Yasuhara, Kiyomitsu, Kuwada, Noriaki, Katada, Yoshiaki, Hashiguchi, Hitoki, Uzuka, Takeshi, Murai, Yuta, Nakazawa, Tomohiro Junji, Kawaharada, Nobuyoshi
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 29.03.2024
• Subjects: Vascular Disease; Endoleaks; Endovascular aneurysm repair; Pararenal aortic aneurysm; Thoracoabdominal aortic aneurysm; Physician-modified endograft
• ISSN: 2753-670X; 2753-670X
• DOI: 10.1093/icvts/ivae044

Abstract OBJECTIVES Our goal was to evaluate early and mid-term outcomes of physician-modified endografting for pararenal and thoraco-abdominal aortic aneurysms from 10 Japanese aortic centres. METHODS From January 2012 to March 2022, a total of 121 consecutive adult patients who underwent physician-modified endografting for pararenal and thoraco-abdominal aortic aneurysms were enrolled. We analysed early and mid-term postoperative outcomes, including postoperative complications and mortality. RESULTS The pararenal and thoraco-abdominal aortic aneurysm groups included 62 (51.2%) and 59 (48.8%) patients, respectively. The overall in-hospital mortality rate was 5.8% (n  =  7), with mortality rates of 3.2% (n  =  2) and 8.5% (n  =  5) in pararenal and thoraco-abdominal aortic aneurysm groups, respectively (P = 0.225). Type IIIc endoleaks occurred postoperatively in 18 patients (14.9%), with a significantly higher incidence (P = 0.033) in the thoraco-abdominal aortic aneurysm group (22.0%, n  =  13) than in the other group (8.1%, n  =  5). Major adverse events occurred in 7 (11.3%) and 14 (23.7%) patients in pararenal and thoraco-abdominal aortic aneurysm groups (P = 0.074), respectively. The mean follow-up period was 24.2 months. At the 3-year mark, both groups differed significantly in freedom from all-cause mortality (83.3% and 54.1%, P = 0.004), target aneurysm-related mortality (96.8% and 82.7%, P = 0.013) and any reintervention (89.3% and 65.6%, P = 0.002). Univariate and multivariate regression analyses demonstrated that ruptures, thoraco-abdominal aortic aneurysms and postoperative type IIIc endoleaks were associated with an increased risk of all-cause mortality. CONCLUSIONS The mid-term outcomes of physician-modified endografting for pararenal and thoraco-abdominal aortic aneurysms were clinically acceptable and comparable with those in other recently published studies. Notably, pararenal and thoraco-abdominal aortic aneurysms represent distinct pathological entities with different postoperative outcomes. Endovascular aortic repair (EVAR) or thoracic endovascular aortic repair (TEVAR) has become a widely accepted treatment option for aortic aneurysms [1–2].