The effect of Fiber Optic RealShape technology on perioperative and postoperative outcomes following complex abdominal aortic repair.

Background: Ongoing innovations in the minimally invasive management of complex abdominal aortic aneurysms, including physician-modified endografts (PMEG) and, more recently, Fiber Optic RealShape (FORS) technology, have allowed vascular surgeons to expand the surgical indications for and complexity of care to this multifaceted patient population. Prior analyses have demonstrated intraoperative advantages of Fiber Optic RealShape in the management of complex abdominal aortic aneurysms for lower total procedural radiation and cannulation tasks; however, few analyses have evaluated the technology's effect on perioperative and postoperative outcomes.

Methods: All PMEGs performed at our institution between 2020 and 2024 were reviewed retrospectively. Primary intraoperative and perioperative outcomes included fluoroscopy time and dose, target vessel cannulation failure, target vessel dissection or perforation, and perioperative complications. Primary postoperative (6-month) outcomes included target vessel related (type Ic or IIIc) endoleak and target vessel instability, defined as any branch-related complication leading to aneurysm rupture, death, occlusion, component separation, or reintervention. Inverse probability of treatment weighting was used to account for factors of clinical significance. The χ² test, logistic regression, and Cox regression were used to evaluate perioperative outcomes in the weighted cohort.

Results: Between 2020 and 2024, 118 patients received a PMEG: 49 with Fiber Optic RealShape (FORS) and 69 using standard fluoroscopy. Baseline characteristics were similar between groups. After weighting, use of FORS exhibited lower fluoroscopy time (38 minutes vs 56 minutes; P < .01) and air Kerma (429 mGy vs 655 mGy; P = .01). Between FORS and standard fluoroscopy, there were no differences noted in target vessel cannulation failure (4.7% vs 1.0%) or in intraoperative or perioperative target vessel perforation (1.9% vs 1.0%) or dissection (6.7% vs 2.1%) (all P > .05). Perioperative complications were similar between groups (22% vs 21%), including spinal cord ischemia (temporary, 8.4% vs 6.1%; permanent, 2.0% vs 3.9%) and bowel ischemia (0% vs 2.6%). FORS use did demonstrate lower rates of target vessel instability (1.2% vs 10%; P = .02) at 6 months; however, this difference did not persist on multivariable analysis.

Conclusions: Since the implementation of FORS at our institution, when compared with standard fluoroscopy, there have been significantly lower intraoperative fluoroscopy times and total radiation doses, with no difference in target vessel cannulation failure, dissection, perforation, perioperative complications, or target vessel instability at 6 months after a PMEG. Although these data may represent our institution's gradual improvement in expertise with this new technology, our results underscore the importance of additional analyses on this evolving technology as it becomes more integrated into the standard practice of the management of complex aortic pathologies.