Aortic remodeling and survival for chronic post dissection thoracoabdominal aneurysm following physician-modified endograft

Objective

This study aimed to evaluate the midterm outcomes of aortic remodeling, clinical results, and reinterventions following the use of physician-modified endografts (PMEGs) in patients with post dissection thoracoabdominal aneurysms (PD-TAAAs).

Methods

From January 1, 2017, to December 31, 2020, a cohort of 62 patients underwent fenestrated and branched endovascular aortic repair with PMEGs for residual type A and type B aortic dissection. The true lumen (TL) diameter and false lumen statues were assessed at four aortic levels. Data on aortic remodeling, survival rate, and reintervention were collected and analyzed.

Results

Among the 62 patients treated with PMEGs, the overall survival rate and the freedom from reintervention were 94.5% and 79.4% at 5 years, respectively. The mean TL diameter at four levels before surgery was 27.09 ± 4.65 mm, 23.16 ± 5.58 mm, 18.04 ± 4.64 mm, and 15.41 ± 6.79 mm, respectively. The mean diameter of the TL at four levels after 1-year follow-up was 29.3 ± 4.92 mm, 27.47 ± 5.46 mm, 21.79 ± 3.62 mm, and 19.10 ± 4.41 mm, respectively, showing significant increase in TL diameter at all levels (P ≤ .05). The mean follow-up was 5.09 ± 0.71 years, with an overall survival rate of 96.4% (95% confidence interval [CI], 85.9%-99.1%) at 1 year and 94.5% (95% CI, 84.0%-98.2%) at 5 years. The freedom from reintervention rate was 92.7% (95% CI, 81.8%-97.2%) at 1 year and 79.4% (95% CI, 79.4%-96.0%) at 5 years.

Conclusions

PMEGs for chronic dissection TAAAs can complete entry tears exclusion, resulting in satisfactory results. Aortic remodeling is favorable at the downstream aorta. Comprehensive pre-planning and strict follow-up protocol should be adopted to guarantee long-term outcomes.