Outcomes of Elective and Non-elective Fenestrated-branched Endovascular Aortic Repair for Treatment of Thoracoabdominal Aortic Aneurysms

被引：6

作者：

Dias-Neto, Marina ^{[1
]}

Vacirca, Andrea ^{[1
]}

Huang, Ying ^{[1
]}

Baghbani-Oskouei, Aidin ^{[1
]}

Jakimowicz, Tomasz ^{[2
]}

Mendes, Bernardo C. ^{[3
]}

Kolbel, Tilo ^{[4
]}

Sobocinski, Jonathan ^{[5
,6
]}

Bertoglio, Luca ^{[7
,8
]}

Mees, Barend ^{[9
]}

Gargiulo, Mauro ^{[10
,11
]}

Dias, Nuno ^{[12
,13
]}

Schanzer, Andres ^{[14
]}

Gasper, Warren ^{[15
]}

Beck, Adam W. ^{[16
]}

Farber, Mark A. ^{[17
]}

Mani, Kevin ^{[18
]}

Timaran, Carlos ^{[19
]}

Schneider, Darren B. ^{[20
]}

Pedro, Luis Mendes ^{[21
,22
,23
]}

Tsilimparis, Nikolaos ^{[24
]}

Haulon, Stephan ^{[25
]}

Sweet, Matthew P. ^{[26
]}

Ferreira, Emilia ^{[27
]}

Eagleton, Matthew ^{[28
]}

Yeung, Kak Khee ^{[29
]}

Khashram, Manar ^{[30
,31
]}

Jama, Katarzyna ^{[2
]}

Panuccio, Giuseppe ^{[4
]}

Rohlffs, Fiona ^{[4
]}

Mesnard, Thomas ^{[5
,6
]}

Chiesa, Roberto ^{[7
,8
]}

Kahlberg, Andrea ^{[7
,8
]}

Schurink, Geert Willem ^{[9
]}

Lemmens, Charlotte ^{[9
]}

Gallitto, Enrico ^{[10
,11
]}

Faggioli, Gianluca ^{[10
,11
]}

Karelis, Angelos ^{[12
,13
]}

Parodi, Ezequiel ^{[17
]}

Gomes, Vivian ^{[17
]}

Wanhainen, Anders ^{[18
]}

Habib, Mohammed ^{[18
]}

Colon, Jesus Porras ^{[19
]}

Pavarino, Felipe ^{[19
]}

Baig, Mirza S. ^{[19
]}

Melo, Ryan Eduardo Costeloe De ^{[21
,22
,23
,24
]}

Crawford, Sean ^{[25
]}

Zettervall, Sara L. ^{[26
]}

Garcia, Rita ^{[27
]}

Ribeiro, Tiago ^{[27
]}

机构：

[1] Univ Texas Hlth Sci Ctr Houston, McGovern Med Sch, Adv Aort Res Program, Dept Cardiothorac & Vasc Surg, Houston, TX 77030 USA

[2] Med Univ Warsaw, Warsaw, Poland

[3] Mayo Clin, Div Vasc & Endovasc Surg, Rochester, MN USA

[4] Univ Med Ctr Eppendorf UKE, Hamburg, Germany

[5] Univ Lille, CHU Lille, Aort Ctr, Vasc Surg, Lille, France

[6] Univ Lille, CHU Lille, INSERM U1008, Lille, France

[7] Univ Vita Salute San Raffaele, San Raffaele Sci Inst, Dept Vasc Surg, Milan, Italy

[8] Univ & ASST Spedali Civili Hosp Brescia, Dept Sperimental & Clin Sci DSCS, Brescia, Italy

[9] Maastricht Univ, Med Ctr, Dept Vasc Surg, Maastricht, Netherlands

[10] Univ Bologna, Vasc Surg, DIMEC, Bologna, Italy

[11] IRCCS Univ Hosp Policlin S Orsola, Vasc Surg Unit, Bologna, Italy

[12] Skane Univ Hosp, Vasc Ctr, Dept Thorac Surg & Vasc Dis, Malmo, Sweden

[13] Lund Univ, Dept Clin Sci, Malmo, Sweden

[14] Univ Massachusetts, Med Sch, Worcester, MA USA

[15] Univ Calif San Francisco, San Francisco, CA USA

[16] Univ Alabama Birmingham, Birmingham, AL USA

[17] Univ N Carolina, Dept Surg, Div Vasc Surg, Chapel Hill, NC USA

[18] Uppsala Univ, Dept Surg Sci, Div Vasc Surg, Uppsala, Sweden

[19] Univ Texas Southwestern, Clin Heart & Vasc Ctr, Dallas, TX USA

[20] Univ Penn, Perelman Sch Med, Div Vasc Surg & Endovasc Therapy, Philadelphia, PA USA

[21] Ctr Hosp Univ Lisboa Norte, Dept Vasc Surg, Lisbon, Portugal

[22] Univ Lisbon, Fac Med, Lisbon, Portugal

[23] Univ Lisboa CCULRISE, Ctr Cardiovasc, Lisbon, Portugal

[24] Ludwig Maximilians Univ Hosp, Dept Vasc Surg, Munich, Germany

[25] Univ Paris Saclay, Hop Marie Lannelongue, Aort Ctr, Grp Hosp Paris St Joseph, Paris, France

[26] Univ Washington, Dept Surg, Div Vasc Surg, Seattle, WA USA

[27] Ctr Hosp Univ Lisboa Cent, Hosp Santa Marta, Dept Angiol & Vasc Surg, Lisbon, Portugal

[28] Harvard Med Sch, Massachusetts Gen Hosp, Div Vasc & Endovasc Surg, Boston, MA USA

[29] Amsterdam UMC, VU Med Ctr, Amsterdam Cardiovasc Sci, Dept Vasc Surg, Amsterdam, Netherlands

[30] Waikato Hosp, Dept Vasc Surg, Hamilton, New Zealand

[31] Univ Auckland, Dept Surg, Auckland, New Zealand

来源：

ANNALS OF SURGERY | 2023年 / 278卷 / 04期

关键词：

fenestrated-branched endovascular aortic repair; thoracoabdominal aortic aneurysm; non-elective repair; elective repair; MIDTERM OUTCOMES; ENDOGRAFTS; MORTALITY;

D O I：

10.1097/SLA.0000000000005986

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Objective: To describe outcomes after elective and non-elective fenestrated-branched endovascular aortic repair (FB-EVAR) for thoracoabdominal aortic aneurysms (TAAAs). Background: 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 2603 patients (69% males; mean age 72 +/- 10 year old) underwent FB-EVAR for TAAAs. Elective repair was performed in 2187 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 months). 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, 1.92; 95% CI] 1.50-2.44; P < 0.001) and ARM (hazard ratio, 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.

引用

页码：568 / 577

页数：10

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