RS10 - Low-Profile Endografts Are Associated With Increased Risks Of Type I/III Endoleaks In Physician-Modified Fenestrated And Branched Endovascular Repair: Insights from Multicenter International Registry

Thursday, June 5, 2025

8:52 AM – 8:59 AM CT

Location: Morial CC, First Floor, Great Hall A

Submitting & Presenting Author(s)

Sukgu M. Han, MD, MS (he/him/his)

Professor of Surgery, Chief
Keck Medical Center of University of Southern California
Los Angeles, California

Slides

Co-Author(s)

Ryan Gouveia E Melo, MD (he/him/his)

Vascular Surgeon
Vascular Surgery Department, Hospital de Santa Maria, Lisbon, Portugal
Lisbon, Portugal
Alyssa J. Pyun, MD

University of Southern California
Los Angeles, California
Adam W. Beck, MD

Professor of Surgery
University of Alabama Medical Center
Birmingham, Alabama
Bernardo C. Mendes, MD

Professor of Surgery
Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
Los Angeles, California
Marc L. Schermerhorn, MD

Chief of Vascular and Endovascular Surgery
Beth Israel Deaconess Medical Center
Boston, Massachusetts
DA

Donald Adam

Consultant Vascular Surgeon; Lead for Aortic Surgery
University Hospitals Birmingham
Birmingham
AB

Andrew Barleben
Mark A. Farber, MD

Chief, Division of Vascular Surgery - Professor of Surgery
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina
TK

Tilo Kölbel, MD, PhD

Professor
German Aortic Center Hamburg
Hamburg, Germany
Matthew P. Sweet

Professor of Surgery
University of Washington
Seattle, Washington
DB

Daniela Branzan

Professor
University Hospital Leipzig
Gustavo S. Oderich, MD

Vascular Surgeon, Professor of Surgery
Division of Vascular and Endovascular Surgery, University of Texas Health Science Center, Houston
Houston, Texas

Senior Author(s)

NT

Nikolaos Tsilimparis

Chief of Vascular Department
LMU University Hospital Munich
Munich, Germany

Objectives: Physician-modified endografts (PMEG) are widely used for complex abdominal and thoracoabdominal aortic repairs, offering versatility in patient-specific stent graft configurations. Lower-profile (LP) endografts improve deliverability and reduce access site complications compared to standard-profile (SP) devices. However, concerns have been raised about the long-term durability of certain LP devices. Although LP devices have been incorporated into PMEG at many centers, data on its impact on the outcomes are limited. Therefore, this study compared outcomes of LP and SP endografts used during PMEG using an international multicenter database.

Methods: A retrospective analysis of data on patients who underwent PMEG at 19 international centers from 2009 to 2022 was conducted. Patients were grouped by LP or SP aortic endografts used for modification. Baseline patient characteristics, aortic pathologies, modification techniques, and outcomes were compared. Primary outcomes included technical success, 30-day mortality, and type I/III endoleaks. The secondary outcomes were major adverse events (MAE), access site complications, all-cause/aneurysm-related mortality and target vessel instability during follow-up.

Results: Among 1220 patients included (393 LP, 827 SP), the LP group was older and had higher rates of congestive heart failure, any history of smoking, and ASA risk score ≥3 (Table). LP devices were more commonly used in elective cases, short neck aneurysms, post-dissection aneurysms, prior endovascular repairs, and during the latter half of the study period. Reinforced fenestration was the most common modification in both groups, with directional branches and preloaded components more common in the LP groups. LP group required fewer access conduits and reduced radiation dose. There was no difference in technical success (92.5 vs 94.5%, P=0.19), mortality (4.1 vs 6.8%, P=0.06), major adverse events (23.1 vs 25.7%, P=0.38), access-site complications (8.1 vs 11.7%, P=0.06) at 30-days as well as all-cause and aneurysm-related mortality, and target vessel instability during follow-up. However, at mean follow-up of 20 months, significantly higher type I or III endoleaks (23% vs 13%, P < 0.001) were seen in LP group. Furthermore, estimated 4-year branch-related endoleaks (type Ic, IIIc) were higher (HR: 1.65, P=0.014) in the LP group.

Conclusions: The use of LP devices facilitated safe PMEG repair with reduced need for access conduit. However, the higher rates of type I/III and branch-related endoleaks with LP devices raise concerns about their long-term durability. Based on these data, the use of LP devices for PMEG should be approached with caution, in favor of SP devices or company-manufactured devices.