VESS09 - Clinical outcomes and quality of life measures among 5-year survivors of fenestrated-branched endovascular aortic repair in a prospective non-randomized study

Wednesday, June 19, 2024

2:36 PM – 2:45 PM CT

Location: West Building, Level 1, W184bc

Presenting Author only(s)

Lucas Ruiter Kanamori, MD

Postdoctoral Research Fellow
Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
Houston, Texas

Co-Author(s)

DB

Dora Babocs

Postdoctoral research fellow
Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
SS

Safa Savadi

Research Fellow
University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
Houston, Texas
Guilherme B. Lima, MD

Vascular Surgery Resident
Division of Vascular and Endovascular Surgery, Mayo Clinic
Rochester, Minnesota
NS

Naveed U. Saqib

Associate Professor
Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
Houston, Texas
YH

Ying Huang

Associate Professor
Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
Bernardo C. Mendes, MD

Associate Professor of Surgery
Division of Vascular and Endovascular Surgery, Mayo Clinic
Rochester, Minnesota

Senior Author(s)

Gustavo S. Oderich, MD

Professor of Surgery and Chair of Vascular and Endovascular Surgery
Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, McGovern
Houston, Texas

Discussant(s)

VH

Vy T. Ho, MD, MS

Vascular Surgery Resident
Stanford Health Care
Palo Alto, California

Objectives: There is paucity of data on outcomes of fenestrated-branched endovascular aortic repair (FB-EVAR) beyond 5-years follow-up. The aim of this study was to report clinical outcomes and changes in quality of life (QOL) measures among 5-year survivors of FB-EVAR for treatment of complex abdominal (CAAA) and thoracoabdominal aortic aneurysms (TAAA).

Methods: A cohort of consecutive patients enrolled in a prospective, non-randomized study to evaluate FB-EVAR for treatment of CAAAs and TAAAs between 2013 and 2018 was analyzed. Patients who completed 5-year clinical and imaging follow-up and SF-36 QOL were defined as 5-year survivors. Primary end-points were aortic aneurysm rupture (AAR), any secondary intervention, and integrity-related issues (Type IIIB and IIIC endoleak). Secondary end-points were Type IA endoleak, sac regression (>5mm), target artery (TA) instability, TA patency and changes in physical (PCS) and mental component (MCS) QOL scores.

Results: There were 342 patients treated by FB-EVAR during the study period. Of these, three patients (0.9%) died within 30 days, 138 (40%) died > 30 days (97% non-aortic), and 76 (22%) withdrew from the study or had incomplete follow-up. A total of 159 5-year survivors (70% male; mean, 73.77.7 years-old) were analyzed. Aneurysm extent was CAAA in 68 patients (43%) and TAAA in 91 (57%), with an average of 3.80.6 target vessels involved per patient. Median follow-up was 63 months (interquartile range, 59-82). Among 5-year survivors, patient survival was 78.8% (95% CI 71.1-87.4%) at 6-years and 58.9% (95% CI, 47.4-73.3%) at 8-years. Five-year cumulative incidences of AAR, secondary interventions and type IIIB endoleaks were 1.3% (95% CI, 0.0-3.1%), 29.4% (95% CI, 21.9-36.2%) and 3.0% (95% CI, 0.0-6.4%), respectively (Table I); cumulative incidences of Type IA endoleak, sac regression and freedom from TA instability were 1.5% (95% CI, 0.0-4.4%), 45.4% (95% CI, 35.7-53.6%) and 91.7% (95% CI, 89.1-94.3%). There were no conversions to open repair. Compared to baseline QOL measures (Table II), PCS declined after the procedure and increased by 6-months, but still remained lower than baseline values throughout 5-years. There were no negative changes in MCS.

Conclusions: Among 5-year survivors of FB-EVAR, risk of AAR or integrity issues related to the device are low. One out of three patients required secondary intervention. Aneurysm sac shrinkage occurred in half of the patients. The early decline in PCS improves by 6-months but never reaches baseline levels. There is no change in MCS.