Aortic & peripheral vascular diseaseCohort study
Early and Late Aortic-Related Mortality and Rupture After Fenestrated-Branched Endovascular Aortic Repair of Thoracoabdominal Aortic Aneurysms: A Prospective Multicenter Cohort Study
- Prospective cohort study
- multicenter
Authors' conclusion
ARM and aortic rupture are uncommon after elective FB-EVAR of asymptomatic intact TAAAs. Half of the ARMs occurred early, and most of the late deaths were not aortic related.
Study context
- Population
- Patients undergoing elective fenestrated-branched endovascular aortic repair (FB-EVAR) of asymptomatic intact thoracoabdominal aortic aneurysms, 2005–2020
- Participants
- 1,109 patients
- Exposure
- Extent I-III vs Extent IV
- Extent I-IIIn = 589
- Extent IVn = 520reference
- Outcome
- Aortic-related mortality (any early death, or late death from aortic rupture, dissection, malperfusion attributable to aortic disease, or reintervention complications) and aortic rupture
Main finding
As reported in the abstract
Hazard ratio
5.85
95% CI 1.31–26.2
P = 0.02
Extent I-III vs Extent IV
HR 5.85 (95% CI 1.31–26.2); P = 0.02
- Early mortality
- 2.7% (n=30)
- Early aortic rupture
- 0.4% (n=4)
- Late aortic-related mortality (ARM): 30 events; 5-year cumulative incidence
- 3.8% (95% CI, 2.6%-5.4%)
- Late aortic ruptures: 14; 5-year cumulative incidence
- 2.7% (95% CI, 1.2%-4.3%)
- Older age and extent I-III thoracoabdominal aortic aneurysms (TAAAs) independently associated with late ARM
- each P<0.05
Observational data: associations, not effects.
Secondary outcomes
| Outcome | Estimate | P value | |
|---|---|---|---|
| Early mortality, predictor · 30 days or in hospital · associated with early mortality | OR 3.30 (95% CI 1.22–8.02) | P = 0.01 | |
| Late aortic rupture, predictor · associated with late aortic rupture | HR 5.85 (95% CI 1.31–26.2) | P = 0.02 | |
| 0.050.21520Ratio (log scale) |
Early major adverse events
- Early major adverse events
- 20.4% (n=226)
TAAA life-altering events (death, permanent spinal cord injury, permanent dialysis or stroke) · early
- TAAA life-altering events
- 7.7% (n=85)
All-cause mortality · 5 years
- Five-year all-cause mortality
- 45.7% (95% CI, 41.7%-49.4%)
Secondary intervention · 5 years
- Five-year cumulative incidence of secondary intervention
- 40.3% (95% CI, 35.8%-44.5%)
Safety
Early major adverse events and TAAA life-altering events · early (30 days or in hospital)
- Early major adverse events
- 20.4% (n=226)
- TAAA life-altering events (death, permanent spinal cord injury, permanent dialysis or stroke)
- 7.7% (n=85)
Original publication
Early and Late Aortic-Related Mortality and Rupture After Fenestrated-Branched Endovascular Aortic Repair of Thoracoabdominal Aortic Aneurysms: A Prospective Multicenter Cohort Study. Circulation. Published 11 July 2024. doi:10.1161/circulationaha.123.068234
Summarised from the published abstract; every number is checked against it