Clinical Outcomes of Spinal Cord Ischemia after Fenestrated and Branched Endovascular Stent Grafting during Total Endovascular Aortic Repair for Thoracoabdominal Aortic Aneurysms

Abstract

In this single-center study, we assessed the clinical outcomes of fenestrated endovascular aortic repair (f-EVAR) and branched EVAR on morbidity and mortality during total endovascular aortic repair for thoracoabdominal aortic aneurysms (TAAAs). Between July 2006 and June 2015, elective f-EVAR and multibranched EVAR (t-Branch) for TAAAs were performed in 99 patients at our institution (Crawford classification types I [7], II [13], III [6], IV [55], and V [18]). We retrospectively analyzed 44 patients, excluding those with Crawford type IV TAAAs, and compared 30 patients treated with f-EVAR and 14 treated with t-Branch. Multivariate analysis was performed to determine the factors associated with perioperative spinal cord ischemia (SCI). Technical success was 96.7% with f-EVAR and 100% with t-Branch, and the 30-day mortality rate was 3.3% with f-EVAR and 7.1% with t-Branch (P=0.646). The incidences of perioperative SCI were higher with t-Branch (n=5, 35.7%) than those with f-EVAR (n=2, 6.7%; P=0.04). Endoleaks were more prevalent with f-EVAR (n=9, 30.0%) than with t-Branch (n=1, 7.1%; P=0.046). Rates of freedom from aneurysm-related death after 1year for f-EVAR and t-Branch were 96.7 and 92.9%, respectively, and those after 3years were 88.8 and 92.9% (P=0.982), respectively. The risk of SCI remarkably increased in the presence of risk factors such as procedure (t-Branch), maximum short axis of ≥65mm, coverage length of ≥360mm, internal iliac artery occlusion, and ≥ 5 sacrificed intercostal arteries. Our initial to mid-term results of f-EVAR and t-Branch were good with low rates of perioperative mortality and high rates of freedom from aneurysm-related death. SCI incidence with t-Branch was significantly high; it is important to develop additional SCI prevention methods for patients with high-risk factors.