Outcomes of Elective and non-elective fenestrated-branched Endovascular Aortic Repair for Treatment of Thoracoabdominal Aortic Aneurysms

Marina Dias-Neto; Andrea Vacirca; Ying Huang; Aidin Baghbani-Oskouei; Tomasz Jakimowicz; Bernardo C Mendes; Tilo Kolbel; Jonathan Sobocinski; Luca Bertoglio; Barend Mees; Mauro Gargiulo; Nuno Dias; Andres Schanzer; Warren Gasper; Adam W Beck; Mark A Farber; Kevin Mani; Carlos Timaran; Darren B Schneider; Luis Mendes Pedro; Nikolaos Tsilimparis; Stéphan Haulon; Matthew P Sweet; Emília Ferreira; Matthew Eagleton; Kak Khee Yeung; Manar Khashram; Katarzyna Jama; Giuseppe Panuccio; Fiona Rohlffs; Thomas Mesnard; Roberto Chiesa; Andrea Kahlberg; Geert Willem Schurink; Charlotte Lemmens; Enrico Gallitto; Gianluca Faggioli; Angelos Karelis; Ezequiel Parodi; Vivian Gomes; Anders Wanhainen; Mohammed Habib; Jesus Porras Colon; Felipe Pavarino; Mirza S Baig; Ryan Eduardo Costeloe De Gouveia E Melo; Sean Crawford; Sara L Zettervall; Rita Garcia; Tiago Ribeiro; Gustavo S. Oderich; International Multicenter Aortic Research Group

doi:10.1097/SLA.0000000000005986

Outcomes of Elective and non-elective fenestrated-branched Endovascular Aortic Repair for Treatment of Thoracoabdominal Aortic Aneurysms

Marina Dias-Neto, Andrea Vacirca, Ying Huang, Aidin Baghbani-Oskouei, Tomasz Jakimowicz, Bernardo C Mendes, Tilo Kolbel, Jonathan Sobocinski, Luca Bertoglio, Barend Mees, Mauro Gargiulo, Nuno Dias, Andres Schanzer, Warren Gasper, Adam W Beck, Mark A Farber, Kevin Mani, Carlos Timaran, Darren B Schneider, Luis Mendes PedroNikolaos Tsilimparis, Stéphan Haulon, Matthew P Sweet, Emília Ferreira, Matthew Eagleton, Kak Khee Yeung, Manar Khashram, Katarzyna Jama, Giuseppe Panuccio, Fiona Rohlffs, Thomas Mesnard, Roberto Chiesa, Andrea Kahlberg, Geert Willem Schurink, Charlotte Lemmens, Enrico Gallitto, Gianluca Faggioli, Angelos Karelis, Ezequiel Parodi, Vivian Gomes, Anders Wanhainen, Mohammed Habib, Jesus Porras Colon, Felipe Pavarino, Mirza S Baig, Ryan Eduardo Costeloe De Gouveia E Melo, Sean Crawford, Sara L Zettervall, Rita Garcia, Tiago Ribeiro, Gustavo S. Oderich^*, International Multicenter Aortic Research Group

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

OBJECTIVE: To describe outcomes after elective and non-elective fenestrated-branched endovascular aortic repair (FB-EVAR) for thoracoabdominal aortic aneurysms (TAAAs). SUMMARY OF BACKGROUND DATA: 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 2,603 patients (69% males; mean age 72±10 y-old) underwent FB-EVAR for TAAAs. Elective repair was performed in 2,187 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 mo). 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 [HR], 1.92; 95% confidence interval [CI], 1.50-2.44; P <0.001) and ARM (HR, 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.

Original language	English
Pages (from-to)	568-577
Number of pages	10
Journal	Annals of Surgery
Volume	278
Issue number	4
DOIs	https://doi.org/10.1097/SLA.0000000000005986
Publication status	Published - Oct 2023

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Dias-Neto, M., Vacirca, A., Huang, Y., Baghbani-Oskouei, A., Jakimowicz, T., Mendes, B. C., Kolbel, T., Sobocinski, J., Bertoglio, L., Mees, B., Gargiulo, M., Dias, N., Schanzer, A., Gasper, W., Beck, A. W., Farber, M. A., Mani, K., Timaran, C., Schneider, D. B., ... International Multicenter Aortic Research Group (2023). Outcomes of Elective and non-elective fenestrated-branched Endovascular Aortic Repair for Treatment of Thoracoabdominal Aortic Aneurysms. Annals of Surgery, 278(4), 568-577. https://doi.org/10.1097/SLA.0000000000005986

@article{55291940d2f74c3aaaabe8913510e75a,

title = "Outcomes of Elective and non-elective fenestrated-branched Endovascular Aortic Repair for Treatment of Thoracoabdominal Aortic Aneurysms",

abstract = "OBJECTIVE: To describe outcomes after elective and non-elective fenestrated-branched endovascular aortic repair (FB-EVAR) for thoracoabdominal aortic aneurysms (TAAAs). SUMMARY OF BACKGROUND DATA: 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 2,603 patients (69% males; mean age 72±10 y-old) underwent FB-EVAR for TAAAs. Elective repair was performed in 2,187 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 mo). 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 [HR], 1.92; 95% confidence interval [CI], 1.50-2.44; P <0.001) and ARM (HR, 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.",

author = "Marina Dias-Neto and Andrea Vacirca and Ying Huang and Aidin Baghbani-Oskouei and Tomasz Jakimowicz and Mendes, {Bernardo C} and Tilo Kolbel and Jonathan Sobocinski and Luca Bertoglio and Barend Mees and Mauro Gargiulo and Nuno Dias and Andres Schanzer and Warren Gasper and Beck, {Adam W} and Farber, {Mark A} and Kevin Mani and Carlos Timaran and Schneider, {Darren B} and Pedro, {Luis Mendes} and Nikolaos Tsilimparis and St{\'e}phan Haulon and Sweet, {Matthew P} and Em{\'i}lia Ferreira and Matthew Eagleton and Yeung, {Kak Khee} and Manar Khashram and Katarzyna Jama and Giuseppe Panuccio and Fiona Rohlffs and Thomas Mesnard and Roberto Chiesa and Andrea Kahlberg and Schurink, {Geert Willem} and Charlotte Lemmens and Enrico Gallitto and Gianluca Faggioli and Angelos Karelis and Ezequiel Parodi and Vivian Gomes and Anders Wanhainen and Mohammed Habib and Colon, {Jesus Porras} and Felipe Pavarino and Baig, {Mirza S} and {Gouveia E Melo}, {Ryan Eduardo Costeloe De} and Sean Crawford and Zettervall, {Sara L} and Rita Garcia and Tiago Ribeiro and Oderich, {Gustavo S.} and {International Multicenter Aortic Research Group}",

year = "2023",

month = oct,

doi = "10.1097/SLA.0000000000005986",

language = "English",

volume = "278",

pages = "568--577",

journal = "Annals of Surgery",

issn = "0003-4932",

publisher = "LIPPINCOTT WILLIAMS & WILKINS",

number = "4",

}

Dias-Neto, M, Vacirca, A, Huang, Y, Baghbani-Oskouei, A, Jakimowicz, T, Mendes, BC, Kolbel, T, Sobocinski, J, Bertoglio, L, Mees, B, Gargiulo, M, Dias, N, Schanzer, A, Gasper, W, Beck, AW, Farber, MA, Mani, K, Timaran, C, Schneider, DB, Pedro, LM, Tsilimparis, N, Haulon, S, Sweet, MP, Ferreira, E, Eagleton, M, Yeung, KK, Khashram, M, Jama, K, Panuccio, G, Rohlffs, F, Mesnard, T, Chiesa, R, Kahlberg, A, Schurink, GW , Lemmens, C, Gallitto, E, Faggioli, G, Karelis, A, Parodi, E, Gomes, V, Wanhainen, A, Habib, M, Colon, JP, Pavarino, F, Baig, MS, Gouveia E Melo, RECD, Crawford, S, Zettervall, SL, Garcia, R, Ribeiro, T, Oderich, GS & International Multicenter Aortic Research Group 2023, 'Outcomes of Elective and non-elective fenestrated-branched Endovascular Aortic Repair for Treatment of Thoracoabdominal Aortic Aneurysms', Annals of Surgery, vol. 278, no. 4, pp. 568-577. https://doi.org/10.1097/SLA.0000000000005986

TY - JOUR

T1 - Outcomes of Elective and non-elective fenestrated-branched Endovascular Aortic Repair for Treatment of Thoracoabdominal Aortic Aneurysms

AU - Dias-Neto, Marina

AU - Vacirca, Andrea

AU - Huang, Ying

AU - Baghbani-Oskouei, Aidin

AU - Jakimowicz, Tomasz

AU - Mendes, Bernardo C

AU - Kolbel, Tilo

AU - Sobocinski, Jonathan

AU - Bertoglio, Luca

AU - Mees, Barend

AU - Gargiulo, Mauro

AU - Dias, Nuno

AU - Schanzer, Andres

AU - Gasper, Warren

AU - Beck, Adam W

AU - Farber, Mark A

AU - Mani, Kevin

AU - Timaran, Carlos

AU - Schneider, Darren B

AU - Pedro, Luis Mendes

AU - Tsilimparis, Nikolaos

AU - Haulon, Stéphan

AU - Sweet, Matthew P

AU - Ferreira, Emília

AU - Eagleton, Matthew

AU - Yeung, Kak Khee

AU - Khashram, Manar

AU - Jama, Katarzyna

AU - Panuccio, Giuseppe

AU - Rohlffs, Fiona

AU - Mesnard, Thomas

AU - Chiesa, Roberto

AU - Kahlberg, Andrea

AU - Schurink, Geert Willem

AU - Lemmens, Charlotte

AU - Gallitto, Enrico

AU - Faggioli, Gianluca

AU - Karelis, Angelos

AU - Parodi, Ezequiel

AU - Gomes, Vivian

AU - Wanhainen, Anders

AU - Habib, Mohammed

AU - Colon, Jesus Porras

AU - Pavarino, Felipe

AU - Baig, Mirza S

AU - Gouveia E Melo, Ryan Eduardo Costeloe De

AU - Crawford, Sean

AU - Zettervall, Sara L

AU - Garcia, Rita

AU - Ribeiro, Tiago

AU - Oderich, Gustavo S.

AU - International Multicenter Aortic Research Group

PY - 2023/10

Y1 - 2023/10

N2 - OBJECTIVE: To describe outcomes after elective and non-elective fenestrated-branched endovascular aortic repair (FB-EVAR) for thoracoabdominal aortic aneurysms (TAAAs). SUMMARY OF BACKGROUND DATA: 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 2,603 patients (69% males; mean age 72±10 y-old) underwent FB-EVAR for TAAAs. Elective repair was performed in 2,187 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 mo). 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 [HR], 1.92; 95% confidence interval [CI], 1.50-2.44; P <0.001) and ARM (HR, 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.

AB - OBJECTIVE: To describe outcomes after elective and non-elective fenestrated-branched endovascular aortic repair (FB-EVAR) for thoracoabdominal aortic aneurysms (TAAAs). SUMMARY OF BACKGROUND DATA: 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 2,603 patients (69% males; mean age 72±10 y-old) underwent FB-EVAR for TAAAs. Elective repair was performed in 2,187 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 mo). 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 [HR], 1.92; 95% confidence interval [CI], 1.50-2.44; P <0.001) and ARM (HR, 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.

U2 - 10.1097/SLA.0000000000005986

DO - 10.1097/SLA.0000000000005986

M3 - Article

SN - 0003-4932

VL - 278

SP - 568

EP - 577

JO - Annals of Surgery

JF - Annals of Surgery

IS - 4

ER -