Midterm Results of Physician-Modified Stent Grafts for Thoracoabdominal and Complex Abdominal Aortic Aneurysms Repair

Abstract

To assess midterm results of physician-modified stent grafts (PMSG) for the treatment of emergent complex abdominal and thoracoabdominal aortic aneurysms (TAAA) in high-risk patients. All consecutive patients with emergent complex abdominal or TAAA undergoing PMSG technique between January 2012 and July 2019 were retrospectively included. Indications for PMSG were symptomatic aneurysms and rapidly growing aneurysms >70mm. Ruptured aneurysms were excluded. Thirty-three patients (mean age: 74 +/- 11years) were included. The mean aneurysm diameter was 76 +- 20mm. Patients presented with TAAA (n=20, 61%), complex abdominal aortic aneurysms (CAAA, n=9, 27%), type I endoleak after previous endovascular aneurysm repair (n=3, 9%) and intramural aortic hematoma (n=1, 3%). Chimney technique was performed in addition to PMSG in seven cases (21%). Intraoperative adverse events were recorded in seven cases (35%) in the TAAA group and one case (11%) in the CAAA group. In-hospital mortality rate was 15% (n=3) in the TAAA group and 11% (n=1) in the CAAA group. Moderate to severe complications were recorded in 45% of cases (n=15). Spinal cord ischemia occurred in two cases (6%, one case without residual deficit and one with minor motor deficit). One (3%) patient required transient hemodialysis. One patient presented with early aortic rupture and required an open conversion. The mean follow-up duration was 31months (1-79). Overall survival estimates were 81.4% (95% confidence interval [CI]: 63.1.-91.2) at 1year and 71.6% (95% CI: 52.6-84.1) at 2years. Freedom from reintervention rates at 1 and 2years were 61.2% (95% CI: 41.7-75.9) and 57.4% (95% CI: 37.9-72.8). Target vessel primary patency rates at 1 and 2years were 99.2% (95% CI: 94.2-99.9) and 97.7% (95% CI: 90.7-99.4). PMSG for high-risk patients with complex aneurysms provided acceptable technical success and excellent target vessel patency rates but were associated with a 12% in-hospital mortality rate. Reinterventions were frequent. This technique should be limited to selected high-risk patients for whom the risk of rupture in the short-term is deemed too high to wait for graft manufacturing of custom-made device.