Mid-Term Clinical Outcomes of Physician-Modified Endografts: A Single-Center Experience.

BACKGROUND: To evaluate mid-term clinical outcomes of physician-modified endografts (PMEGs) for urgent repair of complex abdominal aortic aneurysms (cAAAs) and thoracoabdominal aortic aneurysms (TAAAs) in a high-volume tertiary center.

METHODS: This retrospective single-center study included 50 consecutive patients who underwent urgent repair using PMEGs between September 2018 and September 2025. Primary end points were technical success and aortic-related mortality. Secondary end points included 30-day mortality, major adverse events (MAEs), reintervention, and target vessel instability (TVI).

RESULTS: During the study period, 390 fenestrated-branched cases were performed in our institution. Among them 50 patients (mean age 74.4 ± 6.5 years; 78.0% male) underwent urgent PMEG repair for cAAA (74.0%) or TAAA (26.0%), with 66.0% presenting with symptomatic aortic pathology and 34.0% with rupture. Technical success was achieved in 96% of cases; one case developed an early type III endoleak requiring reintervention with Palmaz stent deployment, and in one case, coiling of an upper RRA branch was necessary due to rupture. The 30-day mortality rate was 4.0%, and early MAEs occurred in 10.0% of patients. At a median follow-up of 19.5 months (interquartile range (IQR) 3-37), overall mortality was 18.8%, including two aortic-related deaths. Late reinterventions were required in 22.0% of patients, primarily due to endoleaks or graft-related complications. Type III endoleaks related to PMEGs were observed in 6.0%, while target vessel-related endoleak was observed in three patients (6.0%) involving five TVs in total. TVI occurred in 6.0% of patients (five target vessels). All bridging stents remained patent during follow-up. Graft infections were observed in 8.0%, exclusively in patients presenting with penetrating aortic ulcer (PAU) or pseudoaneurysms of the visceral segment, primarily suspicious for infected aneurysms.

CONCLUSION: PMEG repair of cAAAs and TAAAs in urgent settings is feasible, with high technical success and acceptable perioperative morbidity and mortality. Mid-term outcomes suggest comparable durability to elective custom-made devices, particularly when performed in experienced centers using standardized modification techniques. PMEGs remain a valuable solution in time-sensitive scenarios where custom devices are not available.