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S5: Plenary Session 5

SS11 - Comparison of Staging Strategies During Fenestrated-branched Endovascular Aortic Repair of Thoracoabdominal Aortic Aneurysms

Friday, June 17, 2022
8:24 AM - 8:35 AM EDT
Objectives: The aim of this study was to compare outcomes of fenestrated-branched endovascular aortic repair (FB-EVAR) of thoracoabdominal aortic aneurysms (TAAAs) using different staging strategies.

Methods: We reviewed the clinical data of consecutive patients treated by FB-EVAR for Extent I-III TAAAs in 19 centers from the United States and Europe (2006-2021). Data were extracted from institutional prospectively maintained databases and/or electronic patient records. All patients received off-the-shelf or patient-specific manufactured fenestrated-branched stent grafts. Staging strategies included proximal thoracic aortic repair (PTAR), minimally invasive segmental artery coil embolization (MISACE), temporary aneurysm sac perfusion (TASP) or combinations. Endpoints were analysed in patients who had single or multi-stage procedures, including 30-day/in-hospital mortality and major adverse events (MAEs), any spinal cord injury (SCI), permanent paraplegia, patient survival and freedom from aortic-related mortality (ARM).

Results: A total of 1460 patients (62% male; mean age 719 years-old) underwent FB-EVAR of Extent I (10%), Extent II (48%) and Extent III (42%) TAAAs. Of these, 1194 patients (82%) had elective repair and 266 (18%) had urgent repair for ruptured or symptomatic aneurysms. Single-stage approach was used in 669 patients (46%) and multi-stage approach in 791 patients (54%). Staging strategies included PTAR in 631 patients (43%), TASP in 54 (4%), MISACE in 10 (0.7%) and combinations in 96 (7%). 30-day/in-hospital mortality and MAEs were 5% and 21% for elective and 18% and 34% for urgent procedures (P <.0001). Among patients who had elective repair, staging was associated with significantly lower MAEs, new-onset dialysis and a composite of any mortality and permanent paraplegia, with non-significant decrease in rates of 30-day/in-hospital mortality (p=.079), SCI (p=.127) and permanent paraplegia (p=.051) (Table I). There was no difference in rates of 30-day/in-hospital mortality, MAEs, any SCI and permanent paraplegia for PTAR compared to TASP, respectively (4%, 19%, 12% and 6% v. 5%, 12%, 7% and 7%, P>0.05). At 5-years, patient survival and freedom from ARM were similar (P>0.05) among patients who had single stage procedures compared to a staged approach (455% and 844% v 524% and 942%, Figure 1).

Conclusions: Staging of elective FB-EVAR was associated with lower rates of MAEs, new-onset dialysis and a composite of 30-day/in-hospital mortality or permanent paraplegia compared to single stage repair. Mortality and SCI were similar with PTAR or TASP. There was no difference in 5-year patient survival and ARM with single or multiple stage approaches to TAAAs.