SS07 - Multi-center Trans-Atlantic Experience with Fenestrated-branched Endovascular Repair of Chronic Post-dissection Thoracoabdominal Aortic Aneurysms

Objectives: This multi-center international study aimed to analyse outcomes of fenestrated-branched endovascular aortic repairs (FB-EVAR) for treatment of chronic post-dissection thoracoabdominal aortic aneurysms (PD-TAAAs).

Methods: We reviewed the clinical data of consecutive patients treated by FB-EVAR for Extent I-III PD- TAAAs in 14 centers from the United States and Europe (2008-2021). Data were extracted from institutional prospectively maintained databases and electronic patient records. All patients received off-the-shelf or patient-specific manufactured fenestrated-branched stent grafts. Endpoints were any cause mortality and major adverse events (MAEs) at 30-days, technical success, target artery (TA) patency, freedom from TA instability, minor (endovascular with < 12Fr sheath) and major (open or >12Fr sheath) secondary interventions, and patient survival and freedom from aortic-related mortality (ARM).

Results: A total of 229 patients (75% male; median age 67 years [IQR 61-73]) were treated for Extent I (8%), Extent II (65%) and Extent III (27%) PD- TAAAs (Median aneurysm diameter, 65mm [IQR 59-73]) by FB-EVAR. 17 patients (7%) were octogenarians, 196 (86%) were American Society of Anaesthesiologists (ASA) class 3 and 18 (8%) presented with contained ruptured or symptomatic aneurysms. There were 851 renal-mesenteric vessels targeted by 536 fenestrations (63%) and 315 directional branches (37%), with a mean of 3.7 vessels/patient. Technical success was 99%. The 30-day mortality was 3% and MAEs occurred in 29%, including acute kidney injury in 9%, new-onset dialysis in 1%, major stroke in 1%, spinal cord injury in 8% and permanent paraplegia in 3%. Median follow-up was 14 months (IQR 3.5 – 37.3). Patient survival and freedom from ARM were 67±6% and 96±25% at 5 years, respectively (Fig 1). Secondary interventions were needed in 84 patients (37%), including minor procedures in 60 (26%) and major in 28 (12%). There was 1 conversion to open repair ( < 1%). Freedom from any secondary intervention was 47±5% at 5-years (Fig 2). The 5-year primary and secondary patency and freedom from TA instability were 94±2%, 98±1% and 82±3%, respectively.

Conclusions: FB-EVAR was associated with high technical success and low mortality (3%), new-onset dialysis (1%) and permanent paraplegia rates (3%) in patients with chronic PD-TAAAs. Although the procedure is effective against ARM, patient survival was low at 5-years (67%) likely due to advanced age and significant comorbidities. Freedom from secondary interventions at 5-years was 47%, although most were minor procedures and conversion to open repair was needed in only 1 patient. This study highlights the need for continued follow-up surveillance.