Post-dissection Thoraco-abdominal Aortic Aneurysm Managed with Fenestrated or Branched Endovascular Aortic Repair.

OBJECTIVE: Fenestrated or branched endovascular repairs (f/bEVAR) are valuable treatments in patients with chronic post-dissection thoraco-abdominal aneurysms (PD-TAAA). This study aimed to analyse early and follow up outcomes of f/bEVAR.

DESIGN: Thirty day and follow up outcomes of consecutive patients with PD-TAAA treated with f/bEVAR in a tertiary centre over 8 years were retrospectively analysed.

METHODS: All patients presenting with PD-TAAA and managed with f/bEVAR, were eligible. Modified Crawford's classification system was used. Thirty day mortality and major adverse events (MAE) were analysed. Time to event data were estimated with Kaplan-Meier survival analysis.

RESULTS: Fifty five patients (80% men, mean age 63.7 ± 7.7 years) were included: 12 (22%) were managed urgently; 25 (46%) for chronic type B aortic dissection; and the remainder for residual type A aortic dissection. Of these patients, 88% had undergone previous thoracic endovascular aortic repair. Prophylactic cerebrospinal fluid drainage (CSFD) was used in 91%. Fifteen (27%) patients were treated with fEVAR, nine (16%) with fenestrations and branches, and 31 (56%) with bEVAR. False lumen adjunctive procedures were used in 56%. Technical success was achieved in 96% of patients. Thirty day mortality was 7% and MAE rate was 20%. Spinal cord injury (SCI) grades 1 - 3 and grade 3 rates were 13% and 2%, respectively. Mean follow up was 33.0 ± 18.4 months. Survival and freedom from unscheduled re-intervention were 86% (SE 5%) and 55% (SE 8%) at 24 months, respectively. Freedom from target vessel stenosis and occlusion was higher in fEVAR at the 12 month follow up (p = .006) compared with bEVAR.

CONCLUSION: Fenestrated or branched endovascular repairs in patients with PD-TAAA showed high technical success, with acceptable early mortality and MAE rates. The SCI rate was > 10%, despite CSFD use and staged procedures. Almost one-half of patients needed an unscheduled re-intervention within 24 months after f/bEVAR.