Prognostic analysis of fenestrated-branched endovascular aortic repair with physician-modified endografts for repair of complex abdominal and thoracoabdominal aortic aneurysms: a case control study

BACKGROUND: Thoracoabdominal aortic pathologies involving visceral arteries pose complex challenges for endovascular repair. This study aimed to evaluate the clinical outcomes and identify risk factors for adverse events in patients with complex thoracoabdominal aortic aneurysms (CTAAA) who underwent fenestrated-branched endovascular aortic repair (f/b EVAR) using physician-modified endografts (PMEG). METHODS: In this single-center retrospective case-control study, 105 patients undergoing f/b EVAR with at least one visceral artery reconstruction between January 2018 and December 2019 were analyzed. Follow-up was conducted for a median of 36 months. Baseline clinical and imaging characteristics, procedural details, and long-term follow-up data were collected. The primary outcome was patient mortality. Secondary outcomes included technical success, complications, and reinterventions. RESULTS: The technical success rate was 94.3%, with a 30-day mortality rate of 2.86%. During follow-up, 11 patients (10.5%) died, and 15 (14.3%) required reintervention. Analysis of prognostic factors revealed that visceral artery dissection was an independent factor affecting patient survival and positive aortic remodeling, while preoperative renal failure was closely associated with reintervention. Patient age, aortic calcification, and maximum aortic diameter were significant factors influencing endoleak development. CONCLUSIONS: f/b EVAR with PMEG is a safe and effective treatment for CTAAA, with low perioperative mortality and acceptable mid- to long-term outcomes. Preoperative renal function and visceral artery dissection are important predictors of prognosis. Larger studies are needed to further validate these findings.