Language
English
Publication Date
6-4-2026
Journal
Journal of Vascular Surgery
DOI
10.1016/j.jvs.2026.05.044
PMID
42248489
Abstract
Background: This study evaluated the role of target vessel (TV) lumen origin and fenestration gap (FG) distance between the endograft and the aortic wall on TV outcomes following fenestrated-branched endovascular aortic repair (FB-EVAR) for postdissection thoracoabdominal aortic aneurysms (PD-TAAAs).
Methods: A multicenter review of prospectively and retrospectively collected data of patients undergoing FB-EVAR for PD-TAAAs between 2013 and 2023 was performed. Lumen origin was retrospectively analyzed on preoperative imaging studies and classified as true lumen (TL) only, false lumen (FL) only, or both TL and FL. The FG distance was retrospectively measured on postoperative imaging studies and included as a linear variable. Primary outcome measures were freedom from TV instability (TVI), stratified by TV lumen origin and FG distance.
Results: There were 688 patients treated with FB-EVAR; of these 74 patients (11%) (77% male; mean age, 67 ± 10 years) were treated for PD-TAAAs. Company manufactured, patient-specific devices were used in 45 patients (61%), multibranch off-the-shelf device was used in 16 (22%), and physician-modified endografts were used in 13 patients (18%). A total of 280 renal-mesenteric TVs were incorporated by 157 fenestrations (56%) and 123 (44%) directional branches (DBs), with a mean of 3.8 ± 0.5 vessels per patient. TL-TV origin was identified in 200 TVs (71%), FL in 44 TVs (16%), and both TL and FL in 36 TVs (13%). Technical success was achieved in 69 patients (93%) and was not affected by TV origin. Mean follow-up was 35 ± 27 months. Freedom from TVI at 4 years was not affected by lumen origin, including when stratified by fenestrations (87%, 78%, and 75% for TL, FL, and both TL and FL origins; P = .21) and DBs (84%, 53%, and 67% for TL, FL, and both TL and FL origins; P = .17). Similarly, there were no significant differences in TVI when comparing device designs (P = .58) or when comparing fenestrations and DBs (P = .97). Restricted cubic spline modeling demonstrated an accelerating increase in the estimated hazard at FG distances above ∼12 mm. Overall survival and freedom from aortic related mortality at 4 years were 52% and 98% for the entire cohort, with no changes associated with TV origin.
Conclusions: FL-TV origin was not associated with increased rates of TVI or technical failure in patients undergoing FB-EVAR for PD-TAAAs, and thus, attempts should be made to incorporate all renal-mesenteric vessels when appropriate. Importantly, device design was not a predictor of TVI, and similar outcomes were obtained with different stent graft platforms.
Keywords
Aortic aneurysm, Aortic dissection, Bridging stent, Endoleak, Patency, Stent graft
Published Open-Access
yes
Recommended Citation
Tabiei, Armin; Chait, Jesse; Vacirca, Andrea; et al., "Impact of Lumen Origin and Gap Distance on Target Vessel Outcomes Following Fenestrated-Branched Endovascular Aortic Repair of Postdissection Thoracoabdominal Aortic Aneurysms" (2026). Faculty, Staff and Students Publications. 7869.
https://digitalcommons.library.tmc.edu/baylor_docs/7869