Comparison of single- and multistage strategies during fenestrated-branched endovascular aortic repair of thoracoabdominal aortic aneurysms.
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Dias-Neto Marina, Tenorio Emanuel R, Huang Ying, Jakimowicz Tomasz, Mendes Bernardo C, Kölbel Tilo, Sobocinski Jonathan, Bertoglio Luca, Mees Barend, Gargiulo Mauro, Dias Nuno, Schanzer Andres, Gasper Warren, Beck Adam W, Farber Mark A, Mani Kevin, Timaran Carlos, Schneider Darren B, Pedro Luis Mendes, Tsilimparis Nikolaos, Haulon Stéphan, Sweet Matt, Ferreira Emília, Eagleton Matthew, Yeung Kak Khee, Khashram Manar, Vacirca Andrea, Lima Guilherme B, Baghbani Aidin, Jama Katarzyna, Panuccio Giuseppe, Rohlffs Fiona, Chiesa Roberto, Schurink Geert Willem, Lemmens Charlotte, Gallitto Enrico, Faggioli Gianluca, Karelis Angelos, Parodi Ezequiel, Gomes Vivian, Wanhainen Anders, Dean Anastasia, Colon Jesus Porras, Pavarino Felipe, E Melo Ryan Gouveia, Crawford Sean, Garcia Rita, Ribeiro Tiago, Kappe Kaj Olav, van Knippenberg Samira Elize Mariko, Tran Bich Lan, Gormley Sinead, Oderich Gustavo S, International Aortic Research Consortium
Аннотация
METHODS: We reviewed the clinical data of consecutive patients treated by FB-EVAR for extent I to III TAAAs in 24 centers (2006-2021). All patients received a single brand manufactured patient-specific or off-the-shelf fenestrated-branched stent grafts. Staging strategies included proximal thoracic aortic repair, minimally invasive segmental artery coil embolization, temporary aneurysm sac perfusion and combinations of these techniques. Endpoints were analyzed for elective repair in patients who had a single- or multistage approach before and after propensity score adjustment for baseline differences, including the composite 30-day/in-hospital mortality and/or permanent paraplegia, major adverse event, patient survival, and freedom from aortic-related mortality.
RESULTS: A total of 1947 patients (65% male; mean age, 71 ± 8 years) underwent FB-EVAR of 155 extent I (10%), 729 extent II (46%), and 713 extent III TAAAs (44%). A single-stage approach was used in 939 patients (48%) and a multistage approach in 1008 patients (52%). A multistage approach was more frequently used in patients undergoing elective compared with non-elective repair (55% vs 35%; P < .001). Staging strategies were proximal thoracic aortic repair in 743 patients (74%), temporary aneurysm sac perfusion in 128 (13%), minimally invasive segmental artery coil embolization in 10 (1%), and combinations in 127 (12%). Among patients undergoing elective repair (n = 1597), the composite endpoint of 30-day/in-hospital mortality and/or permanent paraplegia rate occurred in 14% of single-stage and 6% of multistage approach patients (P < .001). After adjustment with a propensity score, multistage approach was associated with lower rates of 30-day/in-hospital mortality and/or permanent paraplegia (odds ratio, 0.466; 95% confidence interval, 0.271-0.801; P = .006) and higher patient survival at 1 year (86.9±1.3% vs 79.6±1.7%) and 3 years (72.7±2.1% vs 64.2±2.3%; adjusted hazard ratio, 0.714; 95% confidence interval, 0.528-0.966; P = .029), compared with a single stage approach.
CONCLUSIONS: Staging elective FB-EVAR of extent I to III TAAAs was associated with decreased risk of mortality and/or permanent paraplegia at 30 days or within hospital stay, and with higher patient survival at 1 and 3 years.