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The Journal of Cardiovascular Surgery 2021 December;62(6):582-90

DOI: 10.23736/S0021-9509.21.11877-4


language: English

Evaluation of physician-modified endografts for the treatment of thoraco-abdominal and pararenal aortic pathologies at a single institution

Guangmin YANG 1, 2, Jie ZHAO 1, Leiyang ZHANG 2, Yepeng ZHANG 1, Xiaoqiang LI 1, Min ZHOU 1

1 School of Medicine, Department of Vascular Surgery, Drum Tower Hospital, Nanjing University, Nanjing, China; 2 Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China

BACKGROUND: This study aimed to describe the outcomes of high-risk patients with symptomatic or impending ruptured pararenal aneurysm and thoraco-abdominal aortic aneurysm with comorbidities unsuitable for conventional open surgery, using physician-modified endografts (PMEGs).
METHODS: A single-center retrospective analysis was conducted on 59 patients (mean age: 75 years; 47 males) treated with PMEGs between 2017 and 2020. Data on baseline characteristics, procedures, and clinical follow-up were collected to retrospectively analyze early (technical success, perioperative mortality, and major adverse events) and late (patency, endoleak, intervention, aneurysm thrombosis, and survival) outcomes.
RESULTS: Technical success was achieved in 96.6% (57/59) of cases. The 30-day mortality rate was 5.1% (3/59). Five patients suffered renal failure and required temporary or permanent dialysis, one developed respiratory failure, and one suffered bowel ischemia. The major stroke rate was 3.4%, the spinal cord injury rate was 0%, and the myocardial infarction rate was 3.4%. During a mean follow-up period of 18.8±9.2 months, one patient suffered upper gastrointestinal bleeding and died after 7 postoperative months. Primary branch patency was observed in 97.2% of target vessels. Estimated freedom from reintervention was 88.1% and 87.5% at 6 months and 1 year, respectively. Five cases of endoleak (one type I, one type II, and three type III) were detected, and 7.1% required reintervention. The aneurysmal lumen thrombosis rate at 1 year was 89.6%. The estimated overall survival rate was 94.9% and 92.9% at 6 and 12 months, respectively.
CONCLUSIONS: When used by experienced teams under appropriate anatomical conditions, PMEGs are a safe and effective alternative to open surgery. However, further technical advancement and larger studies with long-term follow-up periods are warranted.

KEY WORDS: Aortic aneurysm; Endovascular procedures; Aorta

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