O-059 - MID-TERM OUTCOMES OF FENESTRATED AND BRANCHED AORTIC REPAIR IN POST-DISSECTION THORACO-ABDOMINAL ANEURYSM.

TOPIC:
Thoraco-abdominal Aortic Disease
AUTHORS:
Bernardini G. (Department of Vascular Surgery and Organ Transplant Unit, University Hospital of Catania ~ Catania ~ Italy) , Abdulhakim I. (Klinik für Vaskuläre und Endovaskuläre Chirurgie, Universitätsklinikum Münster ~ Münster ~ Germany) , Torsello G.B. (Klinik für Vaskuläre und Endovaskuläre Chirurgie, St Franziskus Hospital ~ Münster ~ Germany) , Oberhuber A. (Klinik für Vaskuläre und Endovaskuläre Chirurgie, Universitätsklinikum Münster ~ Münster ~ Germany) , Austermann M. (Klinik für Vaskuläre und Endovaskuläre Chirurgie, St Franziskus Hospital ~ Münster ~ Germany) , Veroux P. (Department of Vascular Surgery and Organ Transplant Unit, University Hospital of Catania ~ Catania ~ Italy) , Bosiers M. (Klinik für Vaskuläre und Endovaskuläre Chirurgie, St Franziskus Hospital ~ Münster ~ Germany)
Introduction:
Post Dissection Thoracoabdominal Aortic Aneurysm (PDTAAA) is traditionally treated with open or hybrid surgery. Total endovascular repair with fenestrated and branched endografts (F/B-EVAR) has recently been introduced as a less invasive alternative. The aim of this study was to outline mid and long-term outcomes of F/B-EVAR in PD-TAAA.
Methods:
A retrospective analysis of prospectively collected data was performed in 2 vascular centers. Patients presenting with PDTAAA treated with F/B-EVAR from December 2010 to November 2019 were included. Perioperative and postoperative parameters were analyzed, with focus on midterm and long-term survival, complication and reintervention rates.
Results:
F/B-EVAR was performed in 42 patients (median age: 66 years; range 46-84 years; 34 men). Twenty-one patients (50%) were treated with BEVAR, 16 (38%) with FEVAR and 5 (12%) with a F/B-EVAR. A total of 161 visceral vessels (29 of which originating from the false lumen) were targeted. Technical success was 100%. Thirty-day mortality rate was 2.4 %. Median follow-up was 24.5 months (range, 0.5- 98 months). Cumulative survival rates at 5, 10, 20, 40 and 60 months were 86.1 ± 5.5%, 83 ± 6.2%, 79.1 ± 7.7%, 78.0 ± 7.9% and 62.4 ± 2.5% respectively. Perioperative complications rate was 14.3%, among which spinal cord ischemia occurred in 9.5%. Endoleaks were found in 27 patients (64.3%), with a total rate of EL type 1a of 7.4%, EL type 1b of 18.5%, EL type 1c of 22.2% and EL type 3 of 14.8%. In the FEVAR group, the total EL rate was 75%, while in the BEVAR group 52%. Reintervention rate was 38.1%. Reasons for reintervention were one occlusion of a bare metal stent and 17 endoleak-related, 9 of them bridging stent graft related while 4 requiring distal extension. Sixty-eight % of reinventions presented with a dissection length of more than 7 segments according to the Lombardi classification and involving visceral ostia.
Conclusion:
Even if endovascular treatment of PDTAA is feasible, with acceptable short-term and midterm outcomes and a low mortality rate, a long term elevated reintervention-rate warrants life-long follow-up.