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P4: Plenary Session 4

SS12 - Urgent endovascular repair of juxta/para-renal aneurysms by off-the-shelf multibranched thoracoabdominal endografts

Thursday, June 20, 2024
11:07 AM – 11:18 AM CT
Location: West Building, Level 3, Skyline Ballroom W375ab
Objectives: To report outcomes of urgent juxta/para-renal aneurysms (J/P-AAAs) managed by off-the-shelf multibranched thoracoabdominal endografts (OTS m-BEVARs)

Methods: In this observational, multi-centers, retrospective study, patients with J/P-AAAs underwent urgent endovascular repair by OTS m-BEVARs (Cook,T-branch) in 23 European aortic centers from 2013 to 2023 were analyzed. Contained J/P-AAAs rupture, symptoms, and aneurysm diameter >70mm were considered as indication for urgent repair. Technical success (TS), spinal cord ischemia (SCI) and 30-day/hospital mortality were assessed as early outcomes. Survival, freedom from (FF) reinterventions and target artery instability (TAI) were evaluated during follow-up. Definitions and results were reported according to the current SVS reporting standard for aneurysms involving renal-mesenteric arteries

Results: Overall, 197 cases [J-AAAs:64(33%), P-AAAs:95(48%), previous failed-EVAR 38(19%)] were analyzed. The mean age and aneurysm diameter was 75+8 years and 76+4 mm, respectively. The ASA score was 3 and 4 in 118(60%) and 79(40%) patients. Rupture, symptoms and diameter >70mm were present in 51(26%), 110(56%) and 131(66%) patients, respectively. An adjunctive proximal thoracic endograft was used in 28(14%) cases. The mean aortic coverage between the upper portion of the endograft and the lowest renal artery was 154+49mm. Single-stage repair and cerebral-spinal-fluid drainage were reported in 144(73%) and 53(27%) cases, respectively. TS was achieved in 182(92%) cases (rupture:84% vs no rupture:95%; P:.02). Failures consist of target artery loss (11: renal artery - 9; celiac trunk - 2), type I-III endoleak (2) and 24-h mortality (2). Rupture was a risk-factor for technical failure (P:.02;OR:3.8;95%CI:1.1-12.1). Overall, 15(8%) patients had persistent SCI (rupture:14% vs no rupture:5%) with 11(6%) cases of paraplegia (rupture:10% vs no rupture:5%; P:.001). Rupture (P:.04;OR:3.1;95%CI:1.1-8.9) and adjunctive proximal thoracic endograft (P:.01;OR:4.1;95%CI:1.3-12.9) were risk-factors for SCI. Twenty-two (11%) patients died within 30-day or during a prolonged hospitalization. Previous failed-EVAR (P:.04;OR:3.6;95%CI:1.1-12.3), paraplegia (P: <.001;OR:9.9;95%CI:1.6-62.2), postoperative mesenteric events (P:.03;OR:10.4;95%CI:1.2-93.3) as well as cardiac (P:.03;OR:8.2;95%CI:2.0-33.0) and respiratory (P: <.001;OR:10.1;95%CI:2.9-35.2) morbidities were associated with 30-day/hospital mortality. The mean follow-up was 19+5months. Estimated 3-year survival and FF-reinterventions was 58% and 77%, respectively. TAI occurred in 27(14%) patients (within 30-day:3-2%, after 30-day: 24-12%; occlusion:15, endoleak:14) with an estimated 3-year FF-TAI of 72%

Conclusions: Urgent repair of J/P-AAAs by OTS m-BEVAR is feasible and effective with satisfactory TS and 30-day/hospital mortality in high-risk patients. However, extensive aortic coverage is necessary, leading to a not negligible SCI rate, especially in aortic rupture or when adjunctive thoracic endografts are necessary. Predictors of TS, SCI and mortality were identified, and they should be considered for surgical indication and outcomes’ optimization