SS18 - Post-Dissection Aortic Aneurysm Sac Enlargement after Fenestrated and Branched Endovascular Repair

Friday, June 21, 2024

10:12 AM – 10:23 AM CT

Location: West Building, Level 3, Skyline Ballroom W375ab

Submitting & Presenting Author(s)

Andres V. Figueroa, MD (he/him/his)

Dallas, Texas

Senior Author(s)

Carlos H. Timaran, MD, MS

Associate Professor
Department of Vascular Surgery UT Southwestern Medical Cente
Dallas, Texas

Co-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
Matthew J. Eagleton, MD (he/him/his)

Chief, Division of Vascular and Endovascular Surgery
Massachusetts General Hospital - Harvard Medical School
Boston, Massachusetts
Andres Schanzer, MD (he/him/his)

Professor
University of Massachusetts Chan Medical School
Worcester, Massachusetts
Mark A. Farber, MD

Professor of Surgery, Chief of Division
University of North Carolina
Chapel Hill, North Carolina
Adam W. Beck, MD

Professor of Surgery
University of Alabama at Birmingham
Birmingham, Alabama
Darren B. Schneider, MD

Professor and Chief, Division of Vascular Surgery and Endovascular Therapy
University of Pennsylvania
Philadelphia, Pennsylvania
WG

Warren J. Gasper, MD

Associate Professor of Surgery
Division of Vascular & Endovascular Surgery, University of California San Francisco
San Francisco, California
Matthew P. Sweet

Professor
University of Washington
Seattle, Washington
AL

Anthony Lee

Objectives: Aneurysm sac changes after fenestrated-branched endovascular aneurysm repair (FBEVAR) for post-dissection thoracoabdominal aortic aneurysms (PDTAAs) are poorly understood. Partial thrombosis of the false lumen and endoleaks may impair sac regression. To characterize sac changes after FBEVAR for PDTAAs, this study examined mid-term results and predictors for sac enlargement.

Methods: FBEVARs performed for PDTAAs in 10 physician-sponsored investigational device exemption studies from 2008-2023 were analyzed. The maximum aortic aneurysm diameter was compared between the 30-day CT angiogram and follow-up imaging studies. Aneurysm sac enlargement was defined as an increase in diameter of at least 5 mm. Kaplan Meier curves and Cox regression were used to evaluate sac enlargement and mid-term FBEVAR outcomes.

Results: Among 3,296 FBEVARs, 290 patients (72.4% male; median age, 68.4 years) were treated for PDTAAs. Most aneurysms treated were extent II (72%) and III (12%). Mean aneurysm diameter was 66.5 ± 11.2 mm. Mortality at 30-days was 1.4%. At a mean follow-up of 2.9 ± 1.9 years, at least one follow-up imaging study revealed sac enlargement in 43 patients (15%), sac regression in 115 patients (40%) and neither enlargement nor regression in 137 (47%); 5 (2%) had expansion and regression. Freedom from aneurysm sac enlargement was 93%, 82% and 80% at 1, 3, 5 years, respectively. Overall, endoleaks were detected in 27 patients (63%) with sac enlargement and 143 patients (58%) without enlargement (P=.54). Sac enlargement was significantly more frequent among older patients (mean age at the index procedure, 70.2±8.9 vs. 66.5±11 years; P=.04; Fig 1) and those with type II endoleaks at 1-year (74% vs. 52%; P=.031; Fig 2). Cox regression revealed age > 70 years at baseline (hazard ratio [HR], 2.146; 95% confidence interval [CI], 1.167-3.944; P=.010) and presence of type II endoleak at 1-year (HR, 2.25; 95% CI, 1.07-4.79; P=.032) were independent predictors for sac enlargement. Patient survival was 92%, 81% and 68% at 1, 3 and 5 years, respectively. Cumulative target vessel instability was 7% and ARM 2% at 5 years. At least 50% of patients required secondary interventions. Sac enlargement did not affect patient survival.

Conclusions: Aneurysm sac enlargement occurs in one-fifth of patients after FBEVAR for PDTAAs. Sac enlargement is more frequent among patients older than 70 and those with persistent type II endoleaks at 1 year. Aneurysm-related mortality at 5 years remains low and overall survival was not associated with sac enlargement.