TH4.5 The introduction of a custom made endograft service for patients with complex thoracoabdominal aneurysm

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Abstract Introduction Custom made endografts represents a technological advance that has been widely adopted across vascular centres in the United Kingdom. The most recent National Vascular Registry report describes in-hospital mortality for complex as 2.3%. We have reviewed the outcome associated with the introduction of a custom made endograft program in a single Scottish Health Board. Methods Index cases were identified from a prospective radiology database with cases identified from 2008 to 2021. We collected patient demographics, pre-operative assessment, peri-operative and procedure related details and information on surveillance and re-intervention. Results There have been 49 cases performed. Most patients were males over the age of 70-years with significant medical co-morbidity. The mean AAA size was 5.8cm. Most of the procedures have been performed under general anaesthesia with percutaneous common femoral access. Procedural complications have included inability to stent target arteries (coeliac axis twice and right renal artery twice). Other complications have included limb ischaemia and haemorrhagic complications from access. Two critical care bed days have been used. The mean duration of hospital stay is 9-days. There have been no deaths on the index admission. During the follow-up period there have been 6 deaths. One of these deaths was from rupture of abdominal aortic aneurysm (secondary to Type III endoleak). Conclusion These data suggest that the case selection for custom made endografts is good. The cost of the device may be off set by a reduction in critical care utilization/hospital bed stay.