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P3: Plenary Session 3

SS08 - Trans-Atlantic Multicenter Experience Utilizing Total Endovascular Aortic Repair Extending from Ascending to Infrarenal Aorta or Iliac Arteries with Fenestrated & Branched Endografts.

Thursday, June 5, 2025
8:20 AM – 8:31 AM CT
Location: Morial CC, First Floor, Great Hall A
Objectives: To report outcomes of total endovascular aortic repair (TEAR: zone 0-9/11) using arch-branched (ARCH-BEVAR) in combination with thoracoabdominal-fenestrated/branched (TAAA-F/BEVAR) endografts.

Methods: This multicenter, trans-Atlantic (US:4; Europe:12) retrospective study analyzed TEAR from 2014 to 2024. Outcomes were defined according to the Society for Vascular Surgery standards. Early outcomes included stroke, spinal cord ischemia (SCI), and 30-day mortality. Mid-term outcomes included survival, freedom from reintervention (FFR), target arteries (TAs) instability and new-cardiovascular events (CVEs) within 1-year.

Results: Ninety-five patients with mean follow-up of 32+29 months were included: 45(47%) and 6(6%) had previous ascending and TAAAs surgery, respectively. Post-dissection TAAAs were present in 46(48%) patients with residual type-A dissections in 34(36%) of these cases. Six (6%) patients had connective tissue disorders. Staged approach, with 1ststage involving ARCH-BEVAR followed by TAAA-F/BEVAR, was consistently used (mean time between two stages: 11±5months). The ARCH-BEVAR design incorporated two and three branches in 41(43%) and 54(57%) cases, respectively. A total of 233 supra-aortic trunks were accommodated: 187(80%) and 46(20%) trunks using anterograde and retrograde configurations, respectively; 36(38%) patients underwent carotid-subclavian bypasses. One (1%) rupture occurred between the staged procedures (successfully managed with off-the-shelf TAAA-BEVAR). Custom-made and off-the-shelf TAAA-F/BEVAR device were used in 79(83%) and 16(17%) cases, respectively. Among 351 abdominal TAs, 208(59%) utilized fenestrations, and 143(41%) branches. Iliac branch devices and prophylactic cerebrospinal-fluid drainage were used in 33(35%) and 11(12%) cases, respectively. There were 12(13%) strokes (ARCH-BEVAR:10; TAAAs-F/BEVAR:2); 5(5%) had modified Rankin Scale score (mRS) >3. Independent determinants of stroke included degenerative TAAAs (P=.02;OR:1.5;95%CI:1.3-200.1) and previous TAAAs surgery (P=.01;OR:27;95%CI:2.3-360.2). Sixteen (17%) patients experienced SCI (ARCH-BEVAR:2; TAAAs-F/BEVAR:14) with 3(3%) cases of paraplegia. Independent determinants of SCI included major adverse events (P= <.001;OR:38;95%CI:5.3-283.5) and iliac branch device (P=.006;OR:14;95%CI:2.2-95.5). Four (4%) patients died within 30-day. Independent determinants of 30-day mortality included stroke with mRS>3 (P=.03;OR:29;95%CI:1.5-589.9). Out of 67(71%) patients with available 1-year follow-up, there were 6(9%) TAs-instabilities and 5(7%) CVEs, respectively. Estimated 3-year survival and FFRs was 79% and 66%, respectively. Aortic-related mortality was 2%. Independent predictors of survival included previous abdominal aortic surgery (P=.001;HR:4.3;95%CI:1.3-13.9), postoperative acute kidney injury (P= <.001;HR:13.9;95%CI:3.6-53.7) and CVEs within 1-year (P=.007;HR:8.2;95%CI:2.1-33.9).

Conclusions: Staged TEAR utilizing ARCH-BEVAR in combination with TAAAs-F/BEVAR is effective, demonstrating satisfactory early/mid-term outcomes, with low aortic-related mortality, acceptable FFRs and TAs-instability. Risks of stroke and SCI remain significant and must be carefully weighed during patient’ selection and treatment planning. Identified predictors of morbidity/ mortality highlight the importance of individualized risk-assessment to optimize outcomes.