Ann Surg Treat Res.  2024 Feb;106(2):106-114. 10.4174/astr.2024.106.2.106.

Midterm outcomes of physician-modified endovascular stent grafts for the treatment of complex abdominal aortic aneurysms in Korea: a retrospective study

• Kim HJ
• Jo EA
• Park HS
• Lee T
• Han S

• KMID: 2552391
• DOI: http://doi.org/10.4174/astr.2024.106.2.106

Abstract

Purpose
Physician-modified endovascular stent grafts (PMEG) are a good treatment option for complex abdominal aortic aneurysms (AAAs), especially in high-risk patients not amenable to open repair, and when commercial fenestrated devices are not available. We report our single-center experience with PMEG for the treatment of complex AAAs.
Methods
We retrospectively reviewed patients who underwent PMEG repair for AAA from November 2016 to September 2020 at our institution. Demographic data, anatomic characteristics, perioperative and postoperative outcomes, major adverse events, and 30-day mortality were analyzed.
Results
We identified 12 patients who underwent PMEG for complex AAA. The mean age was 74 years and the mean maximal AAA diameter was 58.1 mm. Indications for treatment included 4 impending or contained ruptures, 2 mycotic aneurysms, and 6 symptomatic cases. The technical success rate was 91.7%. Aneurysm sac regression was observed in 7 patients (58.3%), including 2 cases of complete regression. There was 1 aneurysm-related mortality at 3 months due to mycotic aneurysm. Also, there was 1 postoperative complication case of transient renal failure requiring temporary dialysis. At 1 year, there was 1 branch occlusion from the initial failed cannulation case and 2 type 1A endoleaks, and there was 1 case of open explantation.
Conclusion
PMEG showed a low technical failure rate and acceptable midterm stent durability and sac stability, comparable to conventional endovascular aneurysm repair. Despite the small number of cases, there was a tendency for a high sac regression rate, although longer follow-up is needed.

Keyword

Abdominal; Aortic aneurysm; Endovascular aneurysm repair

Figure

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  Fig. 1 (A) A case of physician-modified endovascular stent graft for a patient with a 73.0-mm impending rupture abdominal aortic aneurysm with a short neck. The distance between the right renal artery (RRA) and left renal artery was 15 mm. (B) A single left renal fenestration was created. (C) Final angiogram showed patent flow through both renal arteries without endoleak. (D) Comparison of preoperative and postoperative CT scans (77.4 months after operation) shows complete resolution of the aneurysmal sac. (E) Follow-up CT reconstruction demonstrates patent endograft with flow through RRA.

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  Fig. 2 (A) A case of ruptured 51-mm mycotic infrarenal abdominal aortic aneurysm. (B) The patient was treated with 2 renal fenestrations for both renal arteries. (C) Follow-up CT reconstruction demonstrates patent endograft with flow through both renal arteries.

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