Objective: To describe outcomes after elective and non-elective fenestrated-branched endovascular aortic repair (FB-EVAR) for thoracoabdominal aortic aneurysms (TAAAs). Summary of background data: FB-EVAR has been increasingly utilized to treat TAAAs; however, outcomes after non-elective versus elective repair are not well described. Methods: Clinical data of consecutive patients undergoing FB-EVAR for TAAAs at 24 centers (2006-2021) were reviewed. Endpoints including early mortality and major adverse events (MAEs), all-cause mortality, and aortic-related mortality (ARM), were analyzed and compared in patients who had non-elective versus elective repair. Results: A total of 2,603 patients (69% males; mean age 72±10 y-old) underwent FB-EVAR for TAAAs. Elective repair was performed in 2,187 patients (84%) and non-elective repair in 416 patients (16%; 268 [64%] symptomatic, 148 [36%] ruptured). Non-elective FB-EVAR was associated with higher early mortality (17% vs. 5%, P <0.001) and rates of MAEs (34% vs. 20%, P <0.001). Median follow-up was 15 months (interquartile range, 7-37 mo). Survival and cumulative incidence of ARM at 3-years were both lower for non-elective versus elective patients (50±4% vs. 70±1% and 21±3% vs. 7±1%, P <0.001). On multivariable analysis, non-elective repair was associated with increased risk of all-cause mortality (hazard ratio [HR], 1.92; 95% confidence interval [CI], 1.50-2.44; P <0.001) and ARM (HR, 2.43; 95% CI, 1.63-3.62; P <0.001). Conclusions: Non-elective FB-EVAR of symptomatic or ruptured TAAAs is feasible, but carries higher incidence of early MAEs and increased all-cause mortality and ARM than elective repair. Long-term follow-up is warranted to justify the treatment.
Outcomes of Elective and non-elective fenestrated-branched Endovascular Aortic Repair for Treatment of Thoracoabdominal Aortic Aneurysms / Dias-Neto, Marina; Vacirca, Andrea; Huang, Ying; Baghbani-Oskouei, Aidin; Jakimowicz, Tomasz; Mendes, Bernardo C; Kolbel, 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, Matthew P; Ferreira, Emília; Eagleton, Matthew; Yeung, Kak Khee; Khashram, Manar; Jama, Katarzyna; Panuccio, Giuseppe; Rohlffs, Fiona; Mesnard, Thomas; Chiesa, Roberto; Kahlberg, Andrea; Schurink, Geert Willem; Lemmens, Charlotte; Gallitto, Enrico; Faggioli, Gianluca; Karelis, Angelos; Parodi, Ezequiel; Gomes, Vivian; Wanhainen, Anders; Habib, Mohammed; Colon, Jesus Porras; Pavarino, Felipe; Baig, Mirza S; Gouveia E Melo, Ryan Eduardo Costeloe De; Crawford, Sean; Zettervall, Sara L; Garcia, Rita; Ribeiro, Tiago; Alves, Gonçalo; Gonçalves, Frederico Bastos; Kappe, Kaj Olav; Mariko van Knippenberg, Samira Elize; Tran, Bich Lan; Gormley, Sinead; Oderich, Gustavo S. - In: ANNALS OF SURGERY. - ISSN 0003-4932. - 278:4(2023), pp. 568-577. (Intervento presentato al convegno 143rd Annual Meeting of the American-Surgical-Association (ASA) tenutosi a Toronto, Canada nel APR 20-22, 2023) [10.1097/SLA.0000000000005986].
Outcomes of Elective and non-elective fenestrated-branched Endovascular Aortic Repair for Treatment of Thoracoabdominal Aortic Aneurysms
Bertoglio, Luca;Chiesa, Roberto;Kahlberg, Andrea;
2023-01-01
Abstract
Objective: To describe outcomes after elective and non-elective fenestrated-branched endovascular aortic repair (FB-EVAR) for thoracoabdominal aortic aneurysms (TAAAs). Summary of background data: FB-EVAR has been increasingly utilized to treat TAAAs; however, outcomes after non-elective versus elective repair are not well described. Methods: Clinical data of consecutive patients undergoing FB-EVAR for TAAAs at 24 centers (2006-2021) were reviewed. Endpoints including early mortality and major adverse events (MAEs), all-cause mortality, and aortic-related mortality (ARM), were analyzed and compared in patients who had non-elective versus elective repair. Results: A total of 2,603 patients (69% males; mean age 72±10 y-old) underwent FB-EVAR for TAAAs. Elective repair was performed in 2,187 patients (84%) and non-elective repair in 416 patients (16%; 268 [64%] symptomatic, 148 [36%] ruptured). Non-elective FB-EVAR was associated with higher early mortality (17% vs. 5%, P <0.001) and rates of MAEs (34% vs. 20%, P <0.001). Median follow-up was 15 months (interquartile range, 7-37 mo). Survival and cumulative incidence of ARM at 3-years were both lower for non-elective versus elective patients (50±4% vs. 70±1% and 21±3% vs. 7±1%, P <0.001). On multivariable analysis, non-elective repair was associated with increased risk of all-cause mortality (hazard ratio [HR], 1.92; 95% confidence interval [CI], 1.50-2.44; P <0.001) and ARM (HR, 2.43; 95% CI, 1.63-3.62; P <0.001). Conclusions: Non-elective FB-EVAR of symptomatic or ruptured TAAAs is feasible, but carries higher incidence of early MAEs and increased all-cause mortality and ARM than elective repair. Long-term follow-up is warranted to justify the treatment.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
