Prevalence of concomitant aneurysms in patients with thoracoabdominal aortic aneurysms who underwent Fenestrated/Branched Endovascular Aortic Repair (F-BEVAR)

OBJECTIVE: To determine the prevalence of synchronous ascending aortic and peripheral arterial aneurysms in patients with Crawford extent I-IV thoracoabdominal aortic aneurysms (TAAA) undergoing fenestrated/branched endovascular aneurysm repair (F/BEVAR). METHODS: We performed a single-center retrospective review of prospectively collected data from patients with Crawford extent I-IV TAAA treated with F/BEVAR under a physician-sponsored investigational device exemption. The preoperative CTA obtained for device planning was used to measure the ascending aorta and bilateral common iliac (CIA), hypogastric (HA), and common femoral (CFA) arteries using centerline reconstruction. Bilateral popliteal artery (PA) diameters were obtained from preoperative arterial duplex imaging. An aneurysm was defined as a vessel diameter >50% greater than the expected normal diameter for that arterial bed, using references available from literature. Multivariable logistic regression included sex, obesity, race/ethnicity, TAAA diameter ≥7 cm, and prior aortic dissection. A sensitivity analysis was performed after excluding patients with prior aortic dissection. RESULTS: Among 249 patients (mean age, 70.8±8.6 years; 40.2% women), 177 (71.1%) had at least one concomitant aneurysm. Race/ethnicity was 75.1% NH-White, 21.7% NH-Black, 0.8% Hispanic, and 2.4% Other. Among evaluable patients, aneurysm prevalence was 12.0% in the ascending aorta (29/242), 62.8% in the CIA (140/223), 42.1% in the HA (98/233), 22.2% in the PA (51/230), and 9.6% in the CFA (22/228). On multivariable analysis, CIA aneurysm was associated with obesity, non-White race/ethnicity, and TAAA diameter ≥7 cm; HA aneurysm with male sex, obesity, and prior dissection; CFA aneurysm with male sex; PA aneurysm with male sex and prior dissection; and ascending aortic aneurysm with TAAA diameter ≥7 cm and prior dissection. After exclusion of 46 patients with prior dissection, concomitant aneurysms remained a common occurrence. CONCLUSIONS: Concomitant aneurysms are common in patients undergoing F/BEVAR for Crawford extent I-IV TAAA. Several associations remained significant after multivariable adjustment. These findings should be interpreted in the context of a single-center referral population, variable arterial-bed denominators, possible diffuse arteriomegaly, and residual confounding. The prevalence of PA aneurysm supports further evaluation of selective popliteal assessment; however, this study does not support a universal screening recommendation or establish an effect on management, outcomes, or cost.