Work

Early Experience of Physician-Modified Endografts for Total Aortic Arch Repair

Year: 2025

Type: article

Abstract: BACKGROUND: Medical and surgical comorbidities may present prohibitive risk for open surgical reconstruction of aortic arch pathology. Also, complex anatomy may preclude use of company-manufactured devices available in repair of aneurysmal aortic arch pathology. We sought to describe early experience with physician-modified endografts for management of aortic arch pathology. METHODS: This was an institutional review board (IRB)-approved retrospective review of prospectively collected data among patients undergoing total endovascular aortic arch repair with a physician-modified endograft (PMEG) in conjunction with cardiothoracic surgery which was performed at a single institution between December 2020 and August 2024. Primary outcomes were technical success, stroke, and target vessel instability. Secondary outcomes included 30-day mortality, spinal cord ischemia, and reinterventions. RESULTS: Nine patients underwent total endovascular repair of the aortic arch with proximal seal in zone 0, with 67% presenting needing urgent or emergent repairs. Repairs were completed using 3 retrograde branches in 3 patients (33%), 3 inner branches in one patient (11%), back-table fenestrations in 3 patients (33%), and laser in situ fenestration in one patient (11%), and the remaining repair was completed with a combination of back-table fenestration and laser in situ fenestration (11%). Technical success was achieved in 8 patients (89%), while access vessel rupture prevented repair in the final patient. With a mean follow-up of 150 days (122-208), there were no instances of target vessel instability observed. One patient suffered a stroke within 30 days (11%), one patient developed pneumonia (11%), and one patient developed bowel ischemia that required laparotomy with resection of necrotic bowel (11%). No patients developed spinal cord ischemia. Four patients died within 30 days of the index intervention (44%), all presenting with acute aortic rupture. Two patients required a reintervention (22%). CONCLUSION: PMEG for total endovascular arch repair presents a possible alternative to open surgical repair or existing company manufactured arch devices in selected patients. Perioperative stroke and mortality risk and rate of reintervention with total endovascular arch repair using a physician-modified device remain significant.

Source: Annals of Vascular Surgery

DOI: 10.1016/j.avsg.2025.10.004