• Annals of surgery · Oct 2023

    Outcomes of Elective and non-elective fenestrated-branched Endovascular Aortic Repair for Treatment of Thoracoabdominal Aortic Aneurysms.

    • Marina Dias-Neto, Andrea Vacirca, Ying Huang, Aidin Baghbani-Oskouei, Tomasz Jakimowicz, Bernardo C Mendes, Tilo Kolbel, Jonathan Sobocinski, Luca Bertoglio, Barend Mees, Mauro Gargiulo, Nuno Dias, Andres Schanzer, Warren Gasper, Adam W Beck, Mark A Farber, Kevin Mani, Carlos Timaran, Darren B Schneider, Luis Mendes Pedro, Nikolaos Tsilimparis, Stéphan Haulon, Matthew P Sweet, Emília Ferreira, Matthew Eagleton, Kak Khee Yeung, Manar Khashram, Katarzyna Jama, Giuseppe Panuccio, Fiona Rohlffs, Thomas Mesnard, Roberto Chiesa, Andrea Kahlberg, Geert Willem Schurink, Charlotte Lemmens, Enrico Gallitto, Gianluca Faggioli, Angelos Karelis, Ezequiel Parodi, Vivian Gomes, Anders Wanhainen, Mohammed Habib, Jesus Porras Colon, Felipe Pavarino, Mirza S Baig, Ryan Eduardo Costeloe De Gouveia E Melo, Sean Crawford, Sara L Zettervall, Rita Garcia, Tiago Ribeiro, Gonçalo Alves, Frederico Bastos Gonçalves, Kaj Olav Kappe, Samira Elize Mariko van Knippenberg, Bich Lan Tran, Sinead Gormley, Gustavo S Oderich, and International Multicenter Aortic Research Group.
    • Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX.
    • Ann. Surg. 2023 Oct 1; 278 (4): 568577568-577.

    ObjectiveTo describe outcomes after elective and non-elective fenestrated-branched endovascular aortic repair (FB-EVAR) for thoracoabdominal aortic aneurysms (TAAAs).BackgroundFB-EVAR has been increasingly utilized to treat TAAAs; however, outcomes after non-elective versus elective repair are not well described.MethodsClinical 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.ResultsA total of 2603 patients (69% males; mean age 72±10 year old) underwent FB-EVAR for TAAAs. Elective repair was performed in 2187 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 months). 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, 1.92; 95% CI] 1.50-2.44; P <0.001) and ARM (hazard ratio, 2.43; 95% CI, 1.63-3.62; P <0.001).ConclusionsNon-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.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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