(PC010) Mid-term Outcomes After Urgent and Emergent In-Situ Laser Fenestrated Endovascular Aortic Repair of Thoracoabdominal and Complex Abdominal Aortic Aneurysms

Objectives: The aim of this study is to present mid-term outcomes of patients treated with laser in-situ fenestrated endovascular aortic repair (LIFE) for ruptured or symptomatic complex abdominal and thoracoabdominal aortic aneurysms (CAAA/TAAA).

Methods: A retrospective analysis of consecutive patients who underwent LIFE for CAAA or TAAA at a single center from 2018 to 2024 was performed. Baseline characteristics, intra-operative variables, post-operative outcomes, and follow-up outcomes were reviewed. The primary outcomes included mid-term survival and freedom from reintervention rates. Secondary outcomes were technical success, in-hospital mortality, major adverse events (MAE), target vessel instability, and type I or III endoleak rates.

Results: Sixty-three patients underwent LIFE during the study period, of whom 61.9% (39/63) had TAAA. Fifty patients (79%) presented with ruptured aneurysms, and 21 (13/63) with symptomatic aneurysms. There were 183 target vessels (mean: 2.9/patient) incorporated including 40 celiac, 55 superior mesenteric, 47 right renal, and 41 left renal arteries. Technical success was 93.7% (59/63) patients, and intraoperative mortality was 4.8% (3/63). In-hospital MAE occurred in 54% (34/63) patients with renal failure being most common (15/63; 23.8%), followed by neurologic complications (stroke or transient ischemic attack 5/63; 7.9%, and spinal cord ischemia 10/63; 15.9%), and mortality 19.0% (12/63). Mean follow-up was 169.2 days (range: 0–1306 days), with an estimated 1-year survival of 74.2% and 2 year survival of 53.2% (Figure 1). Freedom from reintervention was 45.6% at 1- and 2-years (Figure 2). Twenty-four patients (38%) underwent 33 reinterventions. Indications for reintervention included endoleak (60.6%; 20/33), followed by abdominal compartment syndrome or bowel ischemia (21.2%; 7/33), target vessel stenosis (12.1%; 4/33), lower extremity complications (9.1%; 3/33). Target vessel instability was 5.5% (10/183). There were 16 patients with a type I or III endoleak 25.4% (16/63) postoperatively.

Conclusions: LIFE is a feasible treatment option for patients presenting with ruptured or symptomatic CAAA or TAAA. High reintervention and endoleak rates during mid-term follow-up suggest the need for further evaluation and highlight the importance of close follow-up.