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Outcomes of Elective and Non-elective Fenestrated-branched Endovascular Aortic Repair for Treatment of Thoracoabdominal Aortic Aneurysms
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- Dias, N. (författare)
- Lund University,Lunds universitet,Vaskulära sjukdomar - kliniska studier,Forskargrupper vid Lunds universitet,Vascular Diseases - Clinical Research,Lund University Research Groups
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- Vacirca, Andrea (författare)
- Univ Texas Hlth Sci Ctr Houston, McGovern Med Sch, Adv Aort Res Program, Dept Cardiothorac & Vasc Surg, Houston, TX 77030 USA.
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- Huang, Ying (författare)
- Univ Texas Hlth Sci Ctr Houston, McGovern Med Sch, Adv Aort Res Program, Dept Cardiothorac & Vasc Surg, Houston, TX 77030 USA.
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- Grp, Int Multictr Aort Res (författare)
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- (creator_code:org_t)
- Lippincott Williams & Wilkins, 2023
- 2023
- Engelska.
- Ingår i: Annals of Surgery. - : Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 278:4, s. 568-577, s. 568-577
- Tidskriftsartikel (refereegranskat)
Abstract
Ämnesord
Stäng
- Objective: To describe outcomes after elective and non-elective fenestrated-branched endovascular aortic repair (FB-EVAR) for thoracoabdominal aortic aneurysms (TAAAs).Background: FB-EVAR has been increasingly utilized to treat TAAAs; however, outcomes after non-elective versus elective repair are not well described.Methods: 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.Results: 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).Conclusions: 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.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
Nyckelord
- fenestrated-branched endovascular aortic repair
- thoracoabdominal aortic aneurysm
- non-elective repair
- elective repair
- elective repair
- fenestrated-branched endovascular aortic repair
- non-elective repair
- thoracoabdominal aortic aneurysm
- Aged
- Aged, 80 and over
- Aortic Aneurysm, Abdominal
- Aortic Aneurysm, Thoracic
- Aortic Aneurysm, Thoracoabdominal
- Blood Vessel Prosthesis
- Blood Vessel Prosthesis Implantation
- Endovascular Aneurysm Repair
- Endovascular Procedures
- Female
- Humans
- Male
- Middle Aged
- Retrospective Studies
- Risk Factors
- Time Factors
- Treatment Outcome
- aged
- all cause mortality
- aortic related mortality
- Conference Paper
- confidence interval
- cumulative incidence
- elective surgery
- female
- fenestrated endovascular aneurysm repair
- follow up
- hazard ratio
- human
- intermethod comparison
- major clinical study
- male
- mortality
- multivariate analysis
- retrospective study
- thoracoabdominal aorta aneurysm
- abdominal aortic aneurysm
- blood vessel transplantation
- endovascular aneurysm repair
- endovascular surgery
- middle aged
- risk factor
- thoracic aorta aneurysm
- time factor
- treatment outcome
- very elderly
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