Endovascular Repair of Postdissection Aortic Aneurysms Using Physician-Modified Endografts

Background The purpose of this study was to report our experience and evaluate the technical and clinical outcomes of physician-modified endovascular aortic repair of chronic postdissection thoracoabdominal aortic aneurysms. Methods A retrospective analysis of prospectively collected data of consecutive patients presenting with chronic postdissection aneurysms unfit for open surgery and treated by physician-modified stent grafts between January 2016 and December 2019 was conducted. Outcome data were collected retrospectively. Early outcomes included technical success, perioperative mortality, and major adverse events. Late outcomes included reintervention, false lumen thrombosis rate, aneurysm size regression, and survival. Results Sixty-two patients (80.1% men with a mean age of 64 ± 9.9 years) were treated. The technical success was 98.3%. There was 1 (1.6%) death within 30 days. Perioperative major adverse events included respiratory failure (1.6%), spinal cord injury (0%), acute kidney injury (3.2%; 1 dialysis), bowel ischemia (1.6%), myocardial infarction (1.6%), and lower limb ischemia (1.6%). A reintervention was required in 6 (9.8%) patients. The false lumen thrombosis rates were 91.8% (n = 45 of 49) at 1-year follow-up. One patient died during follow-up from an aneurysm-related cause. The estimated overall survival rates were 98.4% and 96.8% at 6 months and 12 months, respectively. Conclusions The report confirmed the feasibility and safety of fenestrated and branched endovascular aortic repair in the setting of postdissection thoracoabdominal aortic aneurysms. Despite the associated perioperative risk and high probability of intended or unintended reintervention, the procedure could lead to favorable aortic remodeling.