RS19 - Ten Years of Physician Modified Endografts

Objectives: Physician modified endografts (PMEGs) have expanded the scope of endovascular abdominal aortic repair beyond the infrarenal aorta. Patients with prohibitively high surgical risk and visceral segment disease are often candidates for this intervention, which mitigates much of the morbidity and mortality associated with conventional open repair. Here we present the institutional PMEG experience of a high-volume aortic center.

Methods: We studied all PMEGs performed at our institution from 2012-2023. This includes cases that were submitted to the FDA in support of an IDE trial, as well as those in the subsequently approved FDA IDE trial. Over this 11-year period we assessed the changes in operative characteristics and perioperative outcomes over time. Additionally, we compared the outcomes from PMEG cases to those of Zenith Fenestrated (ZFEN) grafts (done by the surgeon with the highest number of PMEG cases), an alternative device useful for aneurysms involving the lower visceral segment. Here we assessed operative characteristics, perioperative outcomes, and 5-year survival and reintervention rates using Kaplan-Meier methods.

Results: When assessing the change over time for PMEG operative characteristics, we found a trend towards decreased fluoroscopy time and decreased proportions of completion type-I and type-III endoleaks (all p<.05) (Table I). Perioperative outcomes have remained stable over this period with an overall perioperative mortality rate of 5.1% (noting that this registry also includes cases that were urgent and emergent). Despite the increased complexity of PMEGs relative to ZFENs we found comparable perioperative outcomes with regards to mortality (5.1% vs 4.3%, p=.82), permanent spinal cord ischemia (1.1% vs 0%, p=.38), postoperative MI (3.9% vs 2.9%, p=.70), postoperative respiratory failure (7.3% vs 4.3%, p=.40), and new dialysis usage (2.2% vs 4.3%, p=.37). Additionally, 5-year survival (PMEG 55% vs ZFEN 65%, p=.20) and freedom from reintervention (65% vs 74%, p=.12) were similar between these cohorts (Figure 1).

Conclusions: Throughout our greater than 10-year experience with PMEGs we have noted improvements in operative outcomes, which can likely be attributed to technological advances and increased physician experience. Additionally, we have found that PMEGs perform well when compared to ZFENs, despite being a more complicated repair that is able to treat a larger segment of the aorta. PMEGs are crucial for the comprehensive care of vascular patients with complex aortic disease. As further operative advancements are made, we only expect the usage of this intervention to increase.