Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct 1;278(4):568-577.
doi: 10.1097/SLA.0000000000005986. Epub 2023 Jul 3.

Outcomes of Elective and Non-elective Fenestrated-branched Endovascular Aortic Repair for Treatment of Thoracoabdominal Aortic Aneurysms

Marina Dias-Neto  1 , Andrea Vacirca  1 , Ying Huang  1 , Aidin Baghbani-Oskouei  1 , Tomasz Jakimowicz  2 , Bernardo C Mendes  3 , Tilo Kolbel  4 , Jonathan Sobocinski  5 , Luca Bertoglio  6   7 , Barend Mees  8 , Mauro Gargiulo  9 , Nuno Dias  10 , Andres Schanzer  11 , Warren Gasper  12 , Adam W Beck  13 , Mark A Farber  14 , Kevin Mani  15 , Carlos Timaran  16 , Darren B Schneider  17 , Luis Mendes Pedro  18 , Nikolaos Tsilimparis  19 , Stéphan Haulon  20 , Matthew P Sweet  21 , Emília Ferreira  22 , Matthew Eagleton  23 , Kak Khee Yeung  24 , Manar Khashram  25 , Katarzyna Jama  2 , Giuseppe Panuccio  4 , Fiona Rohlffs  4 , Thomas Mesnard  5 , Roberto Chiesa  6 , Andrea Kahlberg  6 , Geert Willem Schurink  8 , Charlotte Lemmens  8 , Enrico Gallitto  9 , Gianluca Faggioli  9 , Angelos Karelis  10 , Ezequiel Parodi  14 , Vivian Gomes  14 , Anders Wanhainen  15 , Mohammed Habib  15 , Jesus Porras Colon  16 , Felipe Pavarino  16 , Mirza S Baig  16 , Ryan Eduardo Costeloe De Gouveia E Melo  18   19 , Sean Crawford  20 , Sara L Zettervall  21 , Rita Garcia  22 , Tiago Ribeiro  22 , Gonçalo Alves  22 , Frederico Bastos Gonçalves  22 , Kaj Olav Kappe  24 , Samira Elize Mariko van Knippenberg  24 , Bich Lan Tran  24 , Sinead Gormley  25 , Gustavo S Oderich  1 ; International Multicenter Aortic Research Group
Affiliations

Outcomes of Elective and Non-elective Fenestrated-branched Endovascular Aortic Repair for Treatment of Thoracoabdominal Aortic Aneurysms

Marina Dias-Neto et al. Ann Surg. .

Abstract

Objective: To describe outcomes after elective and non-elective fenestrated-branched endovascular aortic repair (FB-EVAR) for thoracoabdominal aortic aneurysms (TAAAs).

Background: FB-EVAR has been increasingly utilized to treat TAAAs; however, outcomes after non-elective versus elective repair are not well described.

Methods: Clinical data of consecutive patients undergoing FB-EVAR for TAAAs at 24 centers (2006-2021) were reviewed. Endpoints including early mortality and major adverse events (MAEs), all-cause mortality, and aortic-related mortality (ARM), were analyzed and compared in patients who had non-elective versus elective repair.

Results: A total of 2603 patients (69% males; mean age 72±10 year old) underwent FB-EVAR for TAAAs. Elective repair was performed in 2187 patients (84%) and non-elective repair in 416 patients [16%; 268 (64%) symptomatic, 148 (36%) ruptured]. Non-elective FB-EVAR was associated with higher early mortality (17% vs 5%, P <0.001) and rates of MAEs (34% vs 20%, P <0.001). Median follow-up was 15 months (interquartile range, 7-37 months). Survival and cumulative incidence of ARM at 3 years were both lower for non-elective versus elective patients (50±4% vs 70±1% and 21±3% vs 7±1%, P <0.001). On multivariable analysis, non-elective repair was associated with increased risk of all-cause mortality (hazard ratio, 1.92; 95% CI] 1.50-2.44; P <0.001) and ARM (hazard ratio, 2.43; 95% CI, 1.63-3.62; P <0.001).

Conclusions: Non-elective FB-EVAR of symptomatic or ruptured TAAAs is feasible, but carries higher incidence of early MAEs and increased all-cause mortality and ARM than elective repair. Long-term follow-up is warranted to justify the treatment.

PubMed Disclaimer

Conflict of interest statement

Consulting, research grants and/or advisory boards: T.J. (Medical University of Warsaw)—Artivion, Cook Medical; B.C.M. (Mayo Clinic)—Cook Medical, WL Gore, Medtronic; T.K. (University of Hamburg)—Cook Medical; J.S.—(University of Lille)—Cookmedical, WLGore, GE Healthcare; L.B. (Hospital San Raffaelle)—Cook Medical; B.M. (Maastricht UMC)—Cook Medical, WL Gore, Phillips, Bentley; M.G. (University of Bologna-DIMEC)—Cook Medical, WL Gore; N.D. (Lund University)—Cook Medical; A.S. (University of Massachusetts)—Cook Medical, Philips, Artivion; A.B. (University of Alabama)—Artivion, Cook Medical, Medtronic, WL Gore, Terumo; K.M. (Uppsala university)—Cook Medical; M.F. (University of North Carolina)—Cook Medical, WL Gore, ViTaaa, Centerline, Getinge; C.T. (University of Texas Southwestern)—Cook Medical, WL Gore; D.B.S. (University of Pennsylvania)—Cook Medical, WL Gore, Endologix, Medtronic; N.T. (Ludwig-Maximilians-University Hospital)—Cook Medical; S.H. (Université Paris Saclay)—Cook Medical, Bentley, and GE healthcare; M.P.S. (University of Washington)—Artivion; E.F. (Universidade NOVA de Lisboa)—Cook Medical, Medtronic; M.E. (Harvard Medical School)—Cook Medical; K.K.Y. (Amsterdam UMC)—Medtronic, W.L. Gore&Associates, Terumo Aortic; G.P. (University of Hamburg)—Cook Medical, Philips; A.K. (Vita-Salute University)—Alvimedica/CID, Boston Scientific, Cordis, Getinge, Medtronic, and Terumo; G.W.S. (Maastricht UMC)—Cook Medical, Philips; S.L.Z. (University of Washington)—WL Gore; G.S.O. (University of Texas Health Science Center)—Cook Medical, WL Gore, GE healthcare, Centerline. The remaining authors report no conflicts of interest.

References

    1. Isselbacher EM, Preventza O, Hamilton Black J III, et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2022;146:e334–e482.
    1. Rigberg DA, McGory ML, Zingmond DS, et al. Thirty-day mortality statistics underestimate the risk of repair of thoracoabdominal aortic aneurysms: a statewide experience. J Vasc Surg. 2006;43:217–222.
    1. Coselli JS, LeMaire SA, Preventza O, et al. Outcomes of 3309 thoracoabdominal aortic aneurysm repairs. J Thorac Cardiovasc Sur g . 2016;151:1323–1337.
    1. Polanco AR, D’Angelo AM, Shea NJ, et al. Increased hospital volume is associated with reduced mortality after thoracoabdominal aortic aneurysm repair. J Vasc Surg. 2021;73:451–458.
    1. Crawford ES, Hess KR, Cohen ES, et al. Ruptured aneurysm of the descending thoracic and thoracoabdominal aorta. Analysis according to size and treatment. Ann Surg. 1991;213:417–425.

Publication types