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 thoracoabdominal aortic aneurysms (TAAAs) in the past decade. This study evaluated the outcomes and experience of 3 high-volume centers.

Methods: Patient data from 3 academic centers in China, spanning from 2017 and 2021, were retrospectively collected and analyzed. Early outcomes were assessed through perioperative morbidity and mortality. Follow-up outcomes included survival, freedom from reintervention, and patency of target vessels.

Results: PMEG procedures were performed in 186 patients (156 men; mean age, 68.4 ± 13.4 years) with TAAAs. Fenestrations or branches were used to incorporate 618 target vessels. Postoperative all-cause mortality 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%). Transient spinal cord injury developed in 1 patient. With a mean follow-up of 3.4 ± 1.3 years, survival rates were 96% at 1 year and 94% 3 years. The secondary patency rates of target vessels at 1 and 3 years were 99% and 98%, and freedom from reintervention was 95% and 91%, respectively.

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