Mid-term outcomes of physician-modified endograft therapy for complex aortic aneurysms

Tsuyoshi Shibata; Hiroshi Mitsuoka; Yutaka Iba; Kenichi Hashizume; Norio Hongo; Kiyomitsu Yasuhara; Noriaki Kuwada; Yoshiaki Katada; Hitoki Hashiguchi; Takeshi Uzuka; Yuta Murai; Tomohiro Junji Nakazawa; Nobuyoshi Kawaharada

doi:10.1093/icvts/ivae044

Mid-term outcomes of physician-modified endograft therapy for complex aortic aneurysms

Interdiscip Cardiovasc Thorac Surg. 2024 Mar 29;38(4):ivae044. doi: 10.1093/icvts/ivae044.

Authors

Affiliations

¹ Department of Cardiovascular Surgery, Sapporo Medical University, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
² Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan.
³ Department of Cardiovascular Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan.
⁴ Department of Radiology, Oita University, Oita, Japan.
⁵ Department of Cardiovascular Surgery, Isesaki Municipal Hospital, Isesaki, Japan.
⁶ Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Japan.
⁷ Department of Radiology, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan.
⁸ Department of Cardiovascular Surgery, Hokkaido Prefectural Kitami Hospital, Kitami, Japan.
⁹ Department of Cardiovascular Surgery, Sunagawa City Medical Center, Sunagawa, Japan.
¹⁰ Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.

Abstract

Objectives: Our goal was to evaluate early and mid-term outcomes of physician-modified endografting for pararenal and thoraco-abdominal aortic aneurysms from 10 Japanese aortic centres.

Methods: From January 2012 to March 2022, a total of 121 consecutive adult patients who underwent physician-modified endografting for pararenal and thoraco-abdominal aortic aneurysms were enrolled. We analysed early and mid-term postoperative outcomes, including postoperative complications and mortality.

Results: The pararenal and thoraco-abdominal aortic aneurysm groups included 62 (51.2%) and 59 (48.8%) patients, respectively. The overall in-hospital mortality rate was 5.8% (n = 7), with mortality rates of 3.2% (n = 2) and 8.5% (n = 5) in pararenal and thoraco-abdominal aortic aneurysm groups, respectively (P = 0.225). Type IIIc endoleaks occurred postoperatively in 18 patients (14.9%), with a significantly higher incidence (P = 0.033) in the thoraco-abdominal aortic aneurysm group (22.0%, n = 13) than in the other group (8.1%, n = 5). Major adverse events occurred in 7 (11.3%) and 14 (23.7%) patients in pararenal and thoraco-abdominal aortic aneurysm groups (P = 0.074), respectively. The mean follow-up period was 24.2 months. At the 3-year mark, both groups differed significantly in freedom from all-cause mortality (83.3% and 54.1%, P = 0.004), target aneurysm-related mortality (96.8% and 82.7%, P = 0.013) and any reintervention (89.3% and 65.6%, P = 0.002). Univariate and multivariate regression analyses demonstrated that ruptures, thoraco-abdominal aortic aneurysms and postoperative type IIIc endoleaks were associated with an increased risk of all-cause mortality.

Conclusions: The mid-term outcomes of physician-modified endografting for pararenal and thoraco-abdominal aortic aneurysms were clinically acceptable and comparable with those in other recently published studies. Notably, pararenal and thoraco-abdominal aortic aneurysms represent distinct pathological entities with different postoperative outcomes.

Keywords: Endoleaks; Endovascular aneurysm repair; Pararenal aortic aneurysm; Physician-modified endograft; Thoracoabdominal aortic aneurysm.