Implementation of a Comprehensive Endovascular Aortic Programme and Maintenance of Clinical Excellence During Fenestrated Branched Endovascular Aortic Repair in Two Centres.

Autor: Kanamori LR; Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, John P. and Kathrine G. McGovern Medical School, Houston, TX, USA., Vacirca A; Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, John P. and Kathrine G. McGovern Medical School, Houston, TX, USA; Vascular Surgery, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy., Babocs D; Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, John P. and Kathrine G. McGovern Medical School, Houston, TX, USA., Tenorio ER; Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, John P. and Kathrine G. McGovern Medical School, Houston, TX, USA., Lima GBB; Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA., Mendes BC; Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA., Huang Y; Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, John P. and Kathrine G. McGovern Medical School, Houston, TX, USA., Maximus S; Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, John P. and Kathrine G. McGovern Medical School, Houston, TX, USA., Estrera A; Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, John P. and Kathrine G. McGovern Medical School, Houston, TX, USA., Oderich GS; Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, John P. and Kathrine G. McGovern Medical School, Houston, TX, USA. Electronic address: gustavo.oderich@uth.tmc.edu.
Jazyk: angličtina
Zdroj: European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery [Eur J Vasc Endovasc Surg] 2024 Nov 19. Date of Electronic Publication: 2024 Nov 19.
DOI: 10.1016/j.ejvs.2024.11.014
Abstrakt: Objective: Comprehensive endovascular aortic programmes need optimal infrastructure and multidisciplinary teams to manage complex aortic aneurysms. This study assessed the implementation of such a programme in two centres and its impact on fenestrated branched endovascular aortic repair (FB-EVAR) outcomes.
Methods: A retrospective review of patients treated for complex abdominal and thoracoabdominal aortic aneurysms (TAAAs) by FB-EVAR between 2013 and 2023 was undertaken. All FB-EVAR patients were analysed, including investigational trials and high risk patients with physician modified endografts. Centre 1 (2013 - 2020) and Centre 2 (2020 - 2023) were compared. Primary endpoints were 30 day/in hospital mortality rate and major adverse events (MAEs). Secondary endpoints were procedural metrics, spinal cord injuries, freedom from all cause mortality, failure to rescue, and one year mortality rate and re-interventions.
Results: A total of 629 patients were included (475, 75.5% at Centre 1 and 154, 24.5% at Centre 2). Median age was 74 years (interquartile range 68, 79) and 441 (70%) were male. Centre 2 had a higher proportion of American Society of Anesthesiology class ≥ 3, genetically triggered aortic diseases (p = .002), chronic post-dissection aneurysms, prior aortic repairs, TAAAs (each p < .001), and symptomatic, larger aneurysms (p < .021). Technical success rates were similar between centres (98% vs. 98%; p = .91). Early mortality was 1.1% (7/629) with no statistically significant difference. No statistically significant differences (p > .050) in new onset permanent dialysis (0.6% vs. 2.0%), major stroke (0.6% vs. 0.6%), and permanent paraplegia (0.8% vs. 2.0%) were observed. Failure to rescue rates were 5% in Centre 2 and 3.5% in Centre 1 (p = .74). The one year mortality rate (91% vs. 89%; p = .71) and re-intervention rate (SHR 1.30; p = .21) were similar between centres.
Conclusion: Fenestrated branched endovascular aortic repair was performed with a low mortality rate and risk of disabling complications. No differences in mortality rate and MAEs were observed after establishing a comprehensive endovascular programme, despite higher risk and more extensive cases at the new institution.
(Copyright © 2024. Published by Elsevier B.V.)
Databáze: MEDLINE
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