Comparison of single- and multistage strategies during fenestrated-branched endovascular aortic repair of thoracoabdominal aortic aneurysms

被引：41

作者：

Dias-Neto, Marina ^{[1
]}

Tenorio, Emanuel R. ^{[1
]}

Huang, Ying ^{[1
]}

Jakimowicz, Tomasz ^{[2
]}

Mendes, Bernardo C. ^{[3
]}

Koelbel, Tilo ^{[4
]}

Sobocinski, Jonathan ^{[5
,6
]}

Bertoglio, Luca ^{[7
]}

Mees, Barend ^{[8
]}

Gargiulo, Mauro ^{[9
]}

Dias, Nuno ^{[10
,11
]}

Schanzer, Andres ^{[12
]}

Gasper, Warren ^{[13
]}

Beck, Adam W. ^{[14
]}

Farber, Mark A. ^{[15
]}

Mani, Kevin ^{[16
]}

Timaran, Carlos ^{[17
]}

Schneider, Darren B. ^{[18
]}

Pedro, Luis Mendes ^{[19
,20
]}

Tsilimparis, Nikolaos ^{[21
]}

Haulon, Stephan ^{[22
]}

Sweet, Matt ^{[23
]}

Ferreira, Emilia ^{[24
,25
]}

Eagleton, Matthew ^{[26
]}

Yeung, Kak Khee ^{[27
]}

Khashram, Manar ^{[28
,29
]}

Vacirca, Andrea ^{[1
]}

Lima, Guilherme B. ^{[1
]}

Baghbani-Oskouei, Aidin ^{[1
]}

Jama, Katarzyna ^{[2
]}

Panuccio, Giuseppe ^{[4
]}

Rohlffs, Fiona ^{[4
]}

Chiesa, Roberto ^{[7
]}

Schurink, Geert Willem ^{[8
]}

Lemmens, Charlotte ^{[8
]}

Gallitto, Enrico ^{[9
]}

Faggioli, Gianluca ^{[9
]}

Karelis, Angelos ^{[10
,11
]}

Parodi, Ezequiel ^{[15
]}

Gomes, Vivian ^{[15
]}

Wanhainen, Anders ^{[16
]}

Dean, Anastasia ^{[16
]}

Colon, Jesus Porras ^{[17
]}

Pavarino, Felipe ^{[17
]}

Melo, Ryan Gouveia e ^{[19
,20
,21
]}

Crawford, Sean ^{[22
]}

Garcia, Rita ^{[24
,25
]}

Ribeiro, Tiago ^{[24
,25
]}

Kappe, Kaj Olav ^{[27
]}

van Knippenberg, Samira Elize Mariko ^{[27
]}

机构：

[1] Univ Texas Hlth Sci Ctr Houston, Houston, TX USA

[2] Med Univ Warsaw, Warsaw, Poland

[3] Mayo Clin, Div Vasc & Endovasc Surg, Rochester, MN USA

[4] Univ Med Ctr Eppendorf UKE, Hamburg, Germany

[5] Univ Lille, Aort Ctr, Vasc Surg, CHU Lille, Lille, France

[6] Univ Lille, INSERM, CHU Lille, Lille, France

[7] Univ Vita Salute San Raffaele, San Raffaele Hosp, Milan, Italy

[8] Maastricht Univ, Med Ctr, Maastricht, Netherlands

[9] Univ Bologna, Univ Hosp Policlin S Orsola, Dept Vasc Surg, Bologna, Italy

[10] Skkne Univ Hosp, Vasc Ctr, Dept Thorac Surg & Vasc Dis, Malmo, Sweden

[11] Lund Univ, Dept Clin Sci Malmo, Malmo, Sweden

[12] Univ Massachusetts, Med Sch, Worcester, MA USA

[13] Univ Calif San Francisco, San Francisco, CA USA

[14] Univ Alabama Birmingham, Birmingham, AL USA

[15] Univ N Carolina, Dept Surg, Div Vasc Surg, Chapel Hill, NC USA

[16] Uppsala Univ, Dept Surg Sci, Div Vasc Surg, Uppsala, Sweden

[17] Univ Texas Southwestern, Clin Heart & Vasc Ctr, Dallas, TX USA

[18] Univ Penn, Perelman Sch Med, Div Vasc Surg & Endovasc Therapy, Philadelphia, PA USA

[19] Hosp Santa Maria CHULN, Dept Vasc Surg, Lisbon, Portugal

[20] Univ Lisbon, Fac Med, Lisbon, Portugal

[21] Ludwig Maximilians Univ Hosp, Dept Vasc Surg, Munich, Germany

[22] Univ Paris Saclay, Hop Marie Lannelongue, Grp Hosp Paris St Joseph, Aort Ctr, Paris, France

[23] Univ Washington, Dept Surg, Div Vasc Surg, Seattle, WA USA

[24] Ctr Hosp Univ Lisboa Cent, Dept Angiol & Vasc Surg, Hosp Santa Marta, Lisbon, Portugal

[25] Univ Nova Lisboa, NOVA Med Sch, Lisbon, Portugal

[26] Massachusetts Gen Hosp, Div Vasc & Endovasc Surg, Boston, MA USA

[27] Vrije Univ Amsterdam Med Ctr, Amsterdam UMC, Amsterdam Cardiovasc Sci, Dept Vasc Surg, Amsterdam, Netherlands

[28] Waikato Hosp, Dept Vasc Surg, Hamilton, New Zealand

[29] Univ Auckland, Dept Surg, Auckland, New Zealand

来源：

JOURNAL OF VASCULAR SURGERY | 2023年 / 77卷 / 06期

关键词：

Fenestrated-branched endovascular aortic repair; Multistage approach; Single stage; Spinal cord injury; Thoracoabdominal aortic aneurysm; SPINAL-CORD ISCHEMIA; COLLATERAL NETWORK; SAC PERFUSION; PARAPLEGIA; PROTECTION; SURGERY; PREVENTION; EXPERIENCE; ADJUNCT; INJURY;

D O I：

10.1016/j.jvs.2023.01.188

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Objective: The aim of this study was to compare outcomes of single or multistage approach during fenestrated-branched endovascular aortic repair (FB-EVAR) of extensive thoracoabdominal aortic aneurysms (TAAAs). Methods: We reviewed the clinical data of consecutive patients treated by FB-EVAR for extent I to III TAAAs in 24 centers (2006-2021). All patients received a single brand manufactured patient-specific or off-the-shelf fenestrated-branched stent grafts. Staging strategies included proximal thoracic aortic repair, minimally invasive segmental artery coil embolization, temporary aneurysm sac perfusion and combinations of these techniques. Endpoints were analyzed for elective repair in patients who had a single-or multistage approach before and after propensity score adjustment for baseline differences, including the composite 30-day/in-hospital mortality and/or permanent paraplegia, major adverse event, patient survival, and freedom from aortic-related mortality. Results: A total of 1947 patients (65% male; mean age, 71 +/- 8 years) underwent FB-EVAR of 155 extent I (10%), 729 extent II (46%), and 713 extent III TAAAs (44%). A single-stage approach was used in 939 patients (48%) and a multistage approach in 1008 patients (52%). A multistage approach was more frequently used in patients undergoing elective compared with non-elective repair (55% vs 35%; P < .001). Staging strategies were proximal thoracic aortic repair in 743 patients (74%), temporary aneurysm sac perfusion in 128 (13%), minimally invasive segmental artery coil embolization in 10 (1%), and combinations in 127 (12%). Among patients undergoing elective repair (n = 1597), the composite endpoint of 30-day/in-hospital mortality and/or permanent paraplegia rate occurred in 14% of single-stage and 6% of multistage approach patients (P < .001). After adjustment with a propensity score, multistage approach was associated with lower rates of 30-day/in-hospital mortality and/or permanent paraplegia (odds ratio, 0.466; 95% confidence interval, 0.271-0.801; P = .006) and higher patient survival at 1 year (86.9 +/- 1.3% vs 79.6 +/- 1.7%) and 3 years (72.7 +/- 2.1% vs 64.2 +/- 2.3%; adjusted hazard ratio, 0.714; 95% confidence interval, 0.528-0.966; P = .029), compared with a single stage approach. Conclusions: Staging elective FB-EVAR of extent I to III TAAAs was associated with decreased risk of mortality and/or permanent paraplegia at 30 days or within hospital stay, and with higher patient survival at 1 and 3 years.

引用

页数：14

共 36 条

[1] Spinal cord protection practices used during endovascular repair of complex aortic aneurysms by the US Aortic Research Consortium [J].