Annals of vascular surgery · 2026
Aneurysm Sac Regression after Fenestrated and Branched Endovascular Repair for Thoracoabdominal Aortic Aneurysms Is Associated with Improved Long-Term Survival.
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Huistra Emiel W M, Tielliu Ignace F J, Gareb Barzi, de Vries Jean-Paul P M, Zeebregts Clark J
Аннотация
BACKGROUND: This study evaluated the association between sac regression at 1 year and long-term outcomes after fenestrated and branched endovascular aortic repair (f/bEVAR) for thoracoabdominal aortic aneurysm (TAAA).
METHODS: A retrospective single-center cohort study was conducted of patients who underwent f/bEVAR for TAAA between April 2006 and March 2025 and had computed tomography angiography (CTA) at 1 year. Sac diameter change was categorized as regression (≥5 mm decrease), stable (±5 mm change), or growth (≥5 mm increase). Stable and growth were combined as failure to regress. The primary outcome was all-cause mortality. Secondary outcomes included late type I/III endoleaks and late reintervention. Kaplan-Meier analysis and Cox models were used.
RESULTS: Sixty eight patients met inclusion criteria. Sac regression 1 year after f/bEVAR occurred in 24 patients (35.3%), whereas 44 (64.7%) demonstrated failure to regress (35 stable, 51.5%; nine growths, 13.2%). Median age was 67.5 years (interquartile range [IQR] 65.0-74.8) and 74.0 years (IQR 68.0-76.8), and 12 (50.0%) and 32 (72.7%) patients were male for the aneurysm regression and failure to regress groups, respectively. During a median follow-up of 56.5 months, overall mortality was 55.9% (38 patients). In a univariable model, failure to regress was significantly associated with higher all-cause mortality (hazard ratio [HR] 2.78, 95% confidence interval [CI] 1.33-5.81; P = 0.007). This association was confirmed in multivariable analysis (HR 2.55, 95% CI 1.14-5.71; P = 0.023). Although there was no association between failure to regress and late type I or III endoleak (HR 1.50, 95% CI 0.48-4.64: P = 0.48), the need for late reintervention was higher for patients with failure to regress (HR 3.03, 95% CI 1.09-8.37; P = 0.033). Notably, all late reinterventions were percutaneous (five main body relinings/extensions; 14 bridging stent-related; two coiling procedures) and did not increase mortality risk (HR 0.95, 95% CI 0.48-1.90; P = 0.89).
CONCLUSION: Aneurysm sac failure to regress at 1 year after f/bEVAR for TAAA is associated with worse long-term survival and increased reintervention rate. The predictive value of aneurysm sac dynamics at 1 year CTA, for adverse outcomes highlights its potential for risk stratification, guiding patient specific treatment regimen.
METHODS: A retrospective single-center cohort study was conducted of patients who underwent f/bEVAR for TAAA between April 2006 and March 2025 and had computed tomography angiography (CTA) at 1 year. Sac diameter change was categorized as regression (≥5 mm decrease), stable (±5 mm change), or growth (≥5 mm increase). Stable and growth were combined as failure to regress. The primary outcome was all-cause mortality. Secondary outcomes included late type I/III endoleaks and late reintervention. Kaplan-Meier analysis and Cox models were used.
RESULTS: Sixty eight patients met inclusion criteria. Sac regression 1 year after f/bEVAR occurred in 24 patients (35.3%), whereas 44 (64.7%) demonstrated failure to regress (35 stable, 51.5%; nine growths, 13.2%). Median age was 67.5 years (interquartile range [IQR] 65.0-74.8) and 74.0 years (IQR 68.0-76.8), and 12 (50.0%) and 32 (72.7%) patients were male for the aneurysm regression and failure to regress groups, respectively. During a median follow-up of 56.5 months, overall mortality was 55.9% (38 patients). In a univariable model, failure to regress was significantly associated with higher all-cause mortality (hazard ratio [HR] 2.78, 95% confidence interval [CI] 1.33-5.81; P = 0.007). This association was confirmed in multivariable analysis (HR 2.55, 95% CI 1.14-5.71; P = 0.023). Although there was no association between failure to regress and late type I or III endoleak (HR 1.50, 95% CI 0.48-4.64: P = 0.48), the need for late reintervention was higher for patients with failure to regress (HR 3.03, 95% CI 1.09-8.37; P = 0.033). Notably, all late reinterventions were percutaneous (five main body relinings/extensions; 14 bridging stent-related; two coiling procedures) and did not increase mortality risk (HR 0.95, 95% CI 0.48-1.90; P = 0.89).
CONCLUSION: Aneurysm sac failure to regress at 1 year after f/bEVAR for TAAA is associated with worse long-term survival and increased reintervention rate. The predictive value of aneurysm sac dynamics at 1 year CTA, for adverse outcomes highlights its potential for risk stratification, guiding patient specific treatment regimen.