Aortic & peripheral vascular disease

Early and Late Aortic-Related Mortality and Rupture After Fenestrated-Branched Endovascular Aortic Repair of Thoracoabdominal Aortic Aneurysms: A Prospective Multicenter Cohort Study

CirculationPublished Prospective cohort study

Main finding · Late aortic ruptureResult — go to the resultHazard ratio 5.85 95% CI 1.31–26.2

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
Methodological detailsmulticenter
  • Multicenter

Main finding

Late aortic rupture

Hazard ratio

5.85

95% CI 1.31–26.2

P = 0.02

Extent I-IIIvs Extent IV
HR 5.85 (95% CI 1.31–26.2); P = 0.02

As reported in the abstract

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

Early mortality, predictor · 30 days or in hospital

OR (95% CI)P value
Congestive heart failureAssociated with early mortality3.30 (1.22–8.02)P = 0.01

Late aortic rupture, predictor

HR (95% CI)P value
Extent I-III TAAAsAssociated with late aortic rupture5.85 (1.31–26.2)P = 0.02

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

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