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Comparison of single- and multistage strategies during fenestrated-branched endovascular aortic repair of thoracoabdominal aortic aneurysms

2023-06Artigo científico Acesso aberto
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dc.contributor.authorDias-Neto, Marina
dc.contributor.authorTenorio, Emanuel R.
dc.contributor.authorHuang, Ying
dc.contributor.authorJakimowicz, Tomasz
dc.contributor.authorMendes, Bernardo C.
dc.contributor.authorKölbel, Tilo
dc.contributor.authorSobocinski, Jonathan
dc.contributor.authorBertoglio, Luca
dc.contributor.authorMees, Barend
dc.contributor.authorGargiulo, Mauro
dc.contributor.authorDias, Nuno
dc.contributor.authorSchanzer, Andres
dc.contributor.authorGasper, Warren
dc.contributor.authorBeck, Adam W.
dc.contributor.authorFarber, Mark A.
dc.contributor.authorMani, Kevin
dc.contributor.authorTimaran, Carlos
dc.contributor.authorSchneider, Darren B.
dc.contributor.authorPedro, Luis Mendes
dc.contributor.authorTsilimparis, Nikolaos
dc.contributor.authorHaulon, Stéphan
dc.contributor.authorSweet, Matt
dc.contributor.authorFerreira, Emília
dc.contributor.authorEagleton, Matthew
dc.contributor.authorYeung, Kak Khee
dc.contributor.authorKhashram, Manar
dc.contributor.authorVacirca, Andrea
dc.contributor.authorLima, Guilherme B.
dc.contributor.authorBaghbani-Oskouei, Aidin
dc.contributor.authorJama, Katarzyna
dc.contributor.authorPanuccio, Giuseppe
dc.contributor.authorRohlffs, Fiona
dc.contributor.authorChiesa, Roberto
dc.contributor.authorSchurink, Geert Willem
dc.contributor.authorLemmens, Charlotte
dc.contributor.authorGallitto, Enrico
dc.contributor.authorFaggioli, Gianluca
dc.contributor.authorKarelis, Angelos
dc.contributor.authorParodi, Ezequiel
dc.contributor.authorGomes, Vivian
dc.contributor.authorWanhainen, Anders
dc.contributor.authorDean, Anastasia
dc.contributor.authorColon, Jesus Porras
dc.contributor.authorPavarino, Felipe
dc.contributor.authore Melo, Ryan Gouveia
dc.contributor.authorCrawford, Sean
dc.contributor.authorGarcia, Rita
dc.contributor.authorRibeiro, Tiago
dc.contributor.authorKappe, Kaj Olav
dc.contributor.authorvan Knippenberg, Samira Elize Mariko
dc.contributor.institutionNOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
dc.contributor.pblElsevier
dc.date.accessioned2026-01-14T13:03:38Z
dc.date.available2026-01-14T13:03:38Z
dc.date.issued2023-06
dc.descriptionFunding Information: Author conflict of interest: Tilo Kolbel reports consulting, research grants and/or advisory boards for Cook Medical and Getinge. Luca Bertoglio reports consulting, research grants and/or advisory boards for Cook Medical. Barend Mees reports consulting, research grants and/or advisory boards for Cook Medical, WL Gore, Phillips, and Bentley. Andres Schanzer reports consulting, research grants and/or advisory boards for Cook Medical, Philips Imaging, Cryolife, and Artivion. Adam Beck reports consulting, research grants and/or advisory boards for Cook Medical, Medtronic, WL Gore, and Terumo. Mark Farber reports consulting, research grants and/or advisory boards for Cook Medical, WL Gore, ViTaaa, Centerline, and Getinge. Carlos Timaran reports consulting, research grants and/or advisory boards for Cook Medical and WL Gore. Gustavo S. Oderich reports consulting, research grants and/or advisory boards for Cook Medical, WL Gore, GE Healthcare, and Centerline. The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest. Publisher Copyright: © 2023 Society for Vascular Surgery
dc.description.abstractObjective: The aim of this study was to compare outcomes of single or multistage approach during fenestrated-branched endovascular aortic repair (FB-EVAR) of extensive thoracoabdominal aortic aneurysms (TAAAs). Methods: We reviewed the clinical data of consecutive patients treated by FB-EVAR for extent I to III TAAAs in 24 centers (2006-2021). All patients received a single brand manufactured patient-specific or off-the-shelf fenestrated-branched stent grafts. Staging strategies included proximal thoracic aortic repair, minimally invasive segmental artery coil embolization, temporary aneurysm sac perfusion and combinations of these techniques. Endpoints were analyzed for elective repair in patients who had a single- or multistage approach before and after propensity score adjustment for baseline differences, including the composite 30-day/in-hospital mortality and/or permanent paraplegia, major adverse event, patient survival, and freedom from aortic-related mortality. Results: A total of 1947 patients (65% male; mean age, 71 ± 8 years) underwent FB-EVAR of 155 extent I (10%), 729 extent II (46%), and 713 extent III TAAAs (44%). A single-stage approach was used in 939 patients (48%) and a multistage approach in 1008 patients (52%). A multistage approach was more frequently used in patients undergoing elective compared with non-elective repair (55% vs 35%; P < .001). Staging strategies were proximal thoracic aortic repair in 743 patients (74%), temporary aneurysm sac perfusion in 128 (13%), minimally invasive segmental artery coil embolization in 10 (1%), and combinations in 127 (12%). Among patients undergoing elective repair (n = 1597), the composite endpoint of 30-day/in-hospital mortality and/or permanent paraplegia rate occurred in 14% of single-stage and 6% of multistage approach patients (P < .001). After adjustment with a propensity score, multistage approach was associated with lower rates of 30-day/in-hospital mortality and/or permanent paraplegia (odds ratio, 0.466; 95% confidence interval, 0.271-0.801; P = .006) and higher patient survival at 1 year (86.9±1.3% vs 79.6±1.7%) and 3 years (72.7±2.1% vs 64.2±2.3%; adjusted hazard ratio, 0.714; 95% confidence interval, 0.528-0.966; P = .029), compared with a single stage approach. Conclusions: Staging elective FB-EVAR of extent I to III TAAAs was associated with decreased risk of mortality and/or permanent paraplegia at 30 days or within hospital stay, and with higher patient survival at 1 and 3 years.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent1254081
dc.identifier.doi10.1016/j.jvs.2023.01.188
dc.identifier.issn0741-5214
dc.identifier.otherPURE: 88864008
dc.identifier.otherPURE UUID: 4d15eeb3-c32c-4ea8-9086-df75d5d80f09
dc.identifier.otherScopus: 85149681136
dc.identifier.otherPubMed: 36731757
dc.identifier.urihttp://hdl.handle.net/10362/198858
dc.identifier.urlhttps://www.scopus.com/pages/publications/85149681136
dc.language.isoeng
dc.peerreviewedyes
dc.subjectFenestrated-branched endovascular aortic repair
dc.subjectMultistage approach
dc.subjectSingle stage
dc.subjectSpinal cord injury
dc.subjectThoracoabdominal aortic aneurysm
dc.subjectSurgery
dc.subjectCardiology and Cardiovascular Medicine
dc.titleComparison of single- and multistage strategies during fenestrated-branched endovascular aortic repair of thoracoabdominal aortic aneurysmsen
dc.typejournal article
degois.publication.firstPage1588
degois.publication.issue6
degois.publication.lastPage1597.e4
degois.publication.titleJournal of Vascular Surgery
degois.publication.volume77
dspace.entity.typePublication
rcaap.rightsopenAccess

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