Midterm outcomes of physician-modified endovascular grafts for repair of postdissection and degenerative thoracoabdominal aortic aneurysms

Objectives: Although physician-modified fenestrated and branched endografts (PMEGs) were proposed as an alternative to thoracoabdominal aortic aneurysms (TAAAs) repair in 2012, PMEG use is still limited by the lack of long-term data in large series. We seek to compare the midterm outcomes of PMEGs in patients with post -dissection (PD) and degenerative (DG) TAAAs. Methods: Data were analyzed for 126 patients (age 68 +/- 13 years; 101 men [80.2%]) with TAAAs treated by PMEGs from 2017 to 2020, including 72 PD-TAAAs and 54 DG-TAAAs. Early and late outcomes were compared between pa-tients with PD-TAAAs and DG-TAAAs, including survival, branch instability, and freedom from endoleak and reintervention. Results: Hypertension and coronary artery disease were present in 109 (86.5%) and 12 (9.5%) patients. PD-TAAA patients were younger (63 +/- 10 vs 75 +/- 12 years; P <.001), and more likely to have diabetes (26.4 vs 11.1; P = .03), his-tory of previous aortic repair (76.4% vs 22.2%; P <.001), and smaller aneurysm size (52 vs 65 mm; P <.001). TAAAs were extent I in 16 (12.7%), II in 63 (50%), III in 14 (11.1%), and IV in 33 (26.2%). Procedural success was 98.6% (71 out of 72) and 96.3% (52 out of 54) for PD-TAAAs and DG-TAAAs (P = .4). The DG-TAAAs group sustained more nonaortic complications than PD-TAAAs (23.7% vs 12.5%; P = .03) in adjusted analysis. Operative mortality was 3.2% (4 out of 126), which didn't differ between the groups (1.4% vs 5.6%; P = .19). The mean follow-up was 3.01 +/- 0.96 years. There were 2 (1.6%) late deaths (from retrograde type A dissection and gastrointestinal bleeding [n =1 each]), 16 (13.1%) endoleaks, and 12 (9.8%) in-stances of branch vessel instability. Reintervention was performed in 15 (12.3%) pa-tients. At 3 years, survival, freedom from any branch instability, and freedom from endoleak and reintervention were 97.2%, 97.3%, 86.9%, and 85.8% in the PD-TAAAs group, respectively, which did not differ significantly from DG-TAAAs pa-tients (92.6%, 97.4%, 90.2%, and 92.3% all P values > .05). Conclusions: Despite the difference in age, diabetes, prior history of aortic repair, and aneurysm size preoperatively, PMEGs achieved similar early and midterm out-comes in PD-TAAAs and DG-TAAAs. Patients with DG-TAAAs were more prone to early nonaortic complications, which represents an aspect for improvement to optimize outcomes and warrants further study. (JTCVS Techniques 2023;18:1-10)