TY - JOUR
T1 - Comparison of single- and multistage strategies during fenestrated-branched endovascular aortic repair of thoracoabdominal aortic aneurysms
AU - Dias-Neto, Marina
AU - Tenorio, Emanuel R.
AU - Huang, Ying
AU - Jakimowicz, Tomasz
AU - Mendes, Bernardo C.
AU - Kölbel, 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, Matt
AU - Ferreira, Emília
AU - Eagleton, Matthew
AU - Yeung, Kak Khee
AU - International Aortic Research Consortium
AU - Khashram, Manar
AU - Varcica, Andrea
AU - Lima, Guilherme B.
AU - Baghbani-Oskouei, Aidin
AU - Jama, Katarzyna
AU - Panuccio, Giuseppe
AU - Rohlffs, Fiona
AU - Chiesa, Roberto
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 - Dean, Anastasia
AU - Colon, Jesus Porras
AU - Pavarino, Felipe
AU - e Melo, Ryan Gouveia
AU - Crawford, Sean
AU - Garcia, Rita
AU - Kappe, Kaj Olav
AU - van Knippenberg, Samira Elize Mariko
AU - Tran, Bich Lan
N1 - Funding Information: Author conflict of interest: Tilo Kolbel reports consulting, research grants and/or advisory boards for Cook Medical and Getinge. Luca Bertoglio reports consulting, research grants and/or advisory boards for Cook Medical. Barend Mees reports consulting, research grants and/or advisory boards for Cook Medical, WL Gore, Phillips, and Bentley. Andres Schanzer reports consulting, research grants and/or advisory boards for Cook Medical, Philips Imaging, Cryolife, and Artivion. Adam Beck reports consulting, research grants and/or advisory boards for Cook Medical, Medtronic, WL Gore, and Terumo. Mark Farber reports consulting, research grants and/or advisory boards for Cook Medical, WL Gore, ViTaaa, Centerline, and Getinge. Carlos Timaran reports consulting, research grants and/or advisory boards for Cook Medical and WL Gore. Gustavo S. Oderich reports consulting, research grants and/or advisory boards for Cook Medical, WL Gore, GE Healthcare, and Centerline. The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest. Publisher Copyright: © 2023 Society for Vascular Surgery
PY - 2023/6
Y1 - 2023/6
N2 - Objective: The aim of this study was to compare outcomes of single or multistage approach during fenestrated-branched endovascular aortic repair (FB-EVAR) of extensive thoracoabdominal aortic aneurysms (TAAAs). 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. Conclusion: 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.
AB - Objective: The aim of this study was to compare outcomes of single or multistage approach during fenestrated-branched endovascular aortic repair (FB-EVAR) of extensive thoracoabdominal aortic aneurysms (TAAAs). 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. Conclusion: 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.
KW - Fenestrated-branched endovascular aortic repair
KW - Multistage approach
KW - Single stage
KW - Spinal cord injury
KW - Thoracoabdominal aortic aneurysm
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85149681136&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/36731757
U2 - https://doi.org/10.1016/j.jvs.2023.01.188
DO - https://doi.org/10.1016/j.jvs.2023.01.188
M3 - Article
C2 - 36731757
SN - 0741-5214
VL - 77
SP - 1588-1597.e4
JO - Journal of vascular surgery
JF - Journal of vascular surgery
IS - 6
ER -