Result of a multicenter study on the Physician-Modified Fenestrated and Branched Endovascular Grafts for thoracoabdominal aneurysms.

Abstract

Background: Physician modified fenestrated and branched endografts (PMEGs) have emerged as an endovascular solution for managing thoraco-abdominal aortic aneurysms (TAAAs) in the past decade. This study aimed to evaluate the outcomes and experience of three high- volume centers.

Methods: Patients' data from three academic center in China, spanning from 2017 and 2021, were retrospectively collected and analyzed. Early outcomes were assessed through peri-operative morbidity and mortality. Follow-up outcomes included survival, freedom from reintervention, and target vessels patency.

Results: A total of 186 patients (156 males; mean age 68.4 ± 13.4 years) with TAAAs underwent PMEG procedures. A total of 618 target vessels were incorporated via fenestrations or branches. Postoperative all-cause was 6.5%, with aneurysm-related deaths accounting for 1.6%. Morbidity included acute kidney injury (5.9%), stroke (1.1%), myocardial infarction (2.7%), and limb ischemia, respiratory failure, and bowel ischemia requiring resection (each 1.6%). One patient developed transient spinal cord injury. With a mean follow-up of 3.4±1.3 years, 1-and 3-year survival rates were 96% and 94%, respectively. The 1-and 3-year secondary patency rates of target vessels were 99% and 98%, while freedom from reintervention rate were 95% and 91%.

Conclusions: Fenestrated and branched endovascular aneurysm repair with PMEGs appears to be a safe and effective treatment for complex aortic aneurysms. While early and mid-term outcomes are promising and comparable to those of custom-made devices, further follow-up is essential to confirm long-term efficacy.