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

医学 四分位间距 择期手术 外科 危险系数 主动脉瘤 置信区间 入射(几何) 动脉瘤 内科学 物理 光学
作者
Marina Dias‐Neto,Andrea Vacirca,Ying Huang,Aidin Baghbani‐Oskouei,Tomasz Jakimowicz,Bernardo C. Mendes,Tilo Kölbel,Jonathan Sobocinski,L. Bertoglio,Barend Mees,Mauro Gargiulo,Nuno Dias,Andres Schanzer,Warren J. Gasper,Adam W. Beck,Mark A. Farber,Kevin Mani,Carlos H. Timaran,Darren B. Schneider,Luís Mendes Pedro,Nikolaos Tsilimparis,Stéphan Haulon,Matthew P. Sweet,E. Ferreira,Matthew J. Eagleton,Kak Khee Yeung,Manar Khashram,Katarzyna Jama,Giuseppe Panuccio,Fiona Rohlffs,Thomas Mesnard,R. Chiesa,Andrea Kahlberg,Geert Willem H. Schurink,Charlotte C. Lemmens,E. Gallitto,G. Faggioli,Angelos Karelis,E Parodi,Vivian Carla Gomes,A. Wanhainen,Mohammad Ahsan Habib,Jesus Porras Colon,Felipe Pavarino,Mirza S. Baig,R. E. C. Gouveia E Melo,Sean A. Crawford,Sara L. Zettervall,Rita Garcia,Tiago Ribeiro,Gonçalo Alves,Frederico Bastos Gonçalves,Kaj O. Kappe,Samira Elize Mariko van Knippenberg,B. L. Tran,Sinead Gormley,Gustavo S. Oderich
出处
期刊:Annals of Surgery [Lippincott Williams & Wilkins]
卷期号:278 (4): 568-577 被引量:10
标识
DOI:10.1097/sla.0000000000005986
摘要

To describe outcomes after elective and non-elective fenestrated-branched endovascular aortic repair (FB-EVAR) for thoracoabdominal aortic aneurysms (TAAAs).FB-EVAR has been increasingly utilized to treat TAAAs; however, outcomes after non-elective versus elective repair are not well described.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.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).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.
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