Outcomes of Total Endovascular Repair of Aortic Arch and Thoraco-abdominal Aortic Aneurysms in the International Multicenter Aortic Research Group in a Selected Group of Patients with Extensive Aortic Aneurysm Disease.

Objective

The aim of this study was to report outcomes of total endovascular aortic repair (TEAR) using arch branched endovascular aortic repair (aBEVAR) and thoraco-abdominal aortic aneurysm (TAAA) fenestrated branched endovascular aortic repair (FBEVAR).

Methods

Clinical data from 16 participating centres in the International Multicenter Aortic Research Group from 2014 to 2024 were retrospectively analysed. All patients who underwent TEAR were included. The primary outcome was aortic related mortality (ARM). Secondary outcomes included stroke and or transient ischaemic attack (TIA), spinal cord ischaemia (SCI), and freedom from target artery (TA) instability, re-interventions, and new cardiovascular events (CVEs) within 1 year.

Results

Of 98 patients scheduled for TEAR, 95 (97%) completed both stages, including 46 (48%) with chronic post-dissection aneurysms and 49 (52%) with degenerative aneurysms. A multistage approach with aBEVAR followed by TAAA FBEVAR was used in all patients, with a median interval between stages of 11 months (interquartile range [IQR] 5, 14). One (1%) rupture occurred between the staged procedures (successfully managed with off the shelf TAAA multibranch stent graft). Custom made and off the shelf TAAA FBEVAR devices were used in 79 (83%) and 16 (17%) patients, respectively. There were 12 (13%) stroke and or TIAs (aBEVAR, ten; TAAA FBEVAR, two); five (5%) had a modified Rankin Scale score > 3. Sixteen patients (17%) experienced SCI (aBEVAR, two; TAAA FBEVAR, 14) with three cases (3%) of paraplegia. Four patients (4%) died within thirty days; these were the only cases of ARM. Median follow up was 32 months (IQR 3, 61). Of 67 patients (71%) with available one year follow up, there were six (9%) with TA instability and five (7%) CVEs. Estimated three year survival was 79 ± 5% with a cumulative incidence of re-intervention of 31 ± 6%.

Conclusion

Multistage TEAR with aBEVAR followed by TAAA FBEVAR was associated with low ARM, re-intervention, and TA instability. Stroke and SCI remain significant and must be carefully weighed during patient selection and treatment.