Comparison of single- and multistage strategies during fenestrated-branched endovascular aortic repair of thoracoabdominal aortic aneurysms
Marina Dias-Neto
,
Emanuel Tenorio
,
Ying Huang
(1)
,
Tomasz Jakimowicz
,
Bernardo Mendes
,
Tilo Kölbel
(2)
,
Jonathan Sobocinski
(3)
,
Luca Bertoglio
,
Barend Mees
(4)
,
Mauro Gargiulo
(5)
,
Nuno Dias
(6)
,
Andres Schanzer
,
Warren Gasper
,
Adam Beck
(7)
,
Mark Farber
(8)
,
Kevin Mani
(9)
,
Carlos Timaran
,
Darren Schneider
,
Luis Mendes Pedro
(10)
,
Nikolaos Tsilimparis
(2)
,
Stéphan Haulon
(11)
,
Matt Sweet
,
Emília Ferreira
,
Matthew Eagleton
,
Kak Khee Yeung
,
Manar Khashram
,
Andrea Vacirca
,
Guilherme Lima
,
Aidin Baghbani-Oskouei
,
Katarzyna Jama
,
Giuseppe Panuccio
,
Fiona Rohlffs
,
Roberto Chiesa
,
Geert Willem Schurink
,
Charlotte Lemmens
,
Enrico Gallitto
,
Gianluca Faggioli
,
Angelos Karelis
,
Ezequiel Parodi
,
Vivian Gomes
,
Anders Wanhainen
,
Anastasia Dean
,
Jesus Porras Colon
,
Felipe Pavarino
,
Ryan Gouveia E Melo
,
Sean Crawford
,
Rita Garcia
,
Tiago Ribeiro
,
Kaj Olav Kappe
,
Samira Elize Mariko van Knippenberg
,
Bich Lan Tran
,
Sinead Gormley
,
Gustavo Oderich
(12)
1
UC Irvine -
University of California [Irvine]
2 University Heart Center [Hamburg]
3 MBLC - ADDS - Médicaments et biomatériaux à libération contrôlée: mécanismes et optimisation - Advanced Drug Delivery Systems - U 1008
4 Departments of Vascular Surgery and of Cell Biology and Genetics Erasmus
5 UNIBO - Alma Mater Studiorum Università di Bologna = University of Bologna
6 Lund University
7 UAB - University of Alabama at Birmingham [ Birmingham]
8 UNC - University of North Carolina [Chapel Hill]
9 Uppsala University Hospital
10 Hospital de Santa Maria [Lisboa]
11 HPPIT - Hypertension pulmonaire : physiopathologie et innovation thérapeutique
12 UTHealth - The University of Texas Health Science Center at Houston
2 University Heart Center [Hamburg]
3 MBLC - ADDS - Médicaments et biomatériaux à libération contrôlée: mécanismes et optimisation - Advanced Drug Delivery Systems - U 1008
4 Departments of Vascular Surgery and of Cell Biology and Genetics Erasmus
5 UNIBO - Alma Mater Studiorum Università di Bologna = University of Bologna
6 Lund University
7 UAB - University of Alabama at Birmingham [ Birmingham]
8 UNC - University of North Carolina [Chapel Hill]
9 Uppsala University Hospital
10 Hospital de Santa Maria [Lisboa]
11 HPPIT - Hypertension pulmonaire : physiopathologie et innovation thérapeutique
12 UTHealth - The University of Texas Health Science Center at Houston
Marina Dias-Neto
- Fonction : Auteur
Emanuel Tenorio
- Fonction : Auteur
Tomasz Jakimowicz
- Fonction : Auteur
Bernardo Mendes
- Fonction : Auteur
Luca Bertoglio
- Fonction : Auteur
Andres Schanzer
- Fonction : Auteur
Warren Gasper
- Fonction : Auteur
Carlos Timaran
- Fonction : Auteur
Darren Schneider
- Fonction : Auteur
Matt Sweet
- Fonction : Auteur
Emília Ferreira
- Fonction : Auteur
Matthew Eagleton
- Fonction : Auteur
Kak Khee Yeung
- Fonction : Auteur
Manar Khashram
- Fonction : Auteur
Andrea Vacirca
- Fonction : Auteur
Guilherme Lima
- Fonction : Auteur
Aidin Baghbani-Oskouei
- Fonction : Auteur
Katarzyna Jama
- Fonction : Auteur
Giuseppe Panuccio
- Fonction : Auteur
Fiona Rohlffs
- Fonction : Auteur
Roberto Chiesa
- Fonction : Auteur
Geert Willem Schurink
- Fonction : Auteur
Charlotte Lemmens
- Fonction : Auteur
Enrico Gallitto
- Fonction : Auteur
Gianluca Faggioli
- Fonction : Auteur
Angelos Karelis
- Fonction : Auteur
Ezequiel Parodi
- Fonction : Auteur
Vivian Gomes
- Fonction : Auteur
Anders Wanhainen
- Fonction : Auteur
Anastasia Dean
- Fonction : Auteur
Jesus Porras Colon
- Fonction : Auteur
Felipe Pavarino
- Fonction : Auteur
Ryan Gouveia E Melo
- Fonction : Auteur
Sean Crawford
- Fonction : Auteur
Rita Garcia
- Fonction : Auteur
Tiago Ribeiro
- Fonction : Auteur
Kaj Olav Kappe
- Fonction : Auteur
Samira Elize Mariko van Knippenberg
- Fonction : Auteur
Bich Lan Tran
- Fonction : Auteur
Sinead Gormley
- Fonction : Auteur
Gustavo Oderich
- Fonction : Auteur
- PersonId : 1367449
- ORCID : 0000-0002-0177-0467
Résumé
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.