Aneurysm sac regression after fenestrated and branched endovascular repair for thoracoabdominal aortic aneurysms is associated with improved long-term survival.
TL;DR
Aneurysm sac failure to regress at one year after f/bEVAR for TAAA is associated with worse long-term survival and increased reintervention rate, and the predictive value of aneurysm sac dynamics at 1 year CTA, for adverse outcomes highlights its potential for risk stratification and guiding patient specific treatment regimen.
Abstract
Objective
This study evaluated the association between sac regression at one year and long-term outcomes after fenestrated and branched endovascular aortic repair (f/bEVAR) for thoracoabdominal aortic aneurysm (TAAA).
Methods
A retrospective single-center cohort study was conducted of patients who underwent f/bEVAR for TAAA between April 2006 and March 2025 and had computed tomography angiography at one year. Sac diameter change was categorized as regression (≥5 mm decrease), stable (+/- 5 mm change), or growth (≥5 mm increase). Stable and growth were combined as failure to regress. The primary outcome was all-cause mortality. Secondary outcomes included late type I/III endoleaks and late reintervention. Kaplan-Meier analysis and Cox models were used.
Results
Sixty-eight patients met inclusion criteria. Sac regression one year after f/bEVAR occurred in 24 patients (35.3%), whereas 44 (64.7%) demonstrated failure to regress (35 stable, 51.5%; nine growths, 13.2%). Median age was 67.5 years (IQR 65.0 - 74.8) and 74.0 years (IQR 68.0 - 76.8), and 12 (50.0%) and 32 (72.7%) patients were male, for the aneurysm regression and failure to regress groups, respectively. During a median follow-up of 56.5 months, overall mortality was 55.9% (38 patients). In a univariable model, failure to regress was significantly associated with higher all-cause mortality (HR 2.78, 95% CI 1.33-5.81; p=.007). This association was confirmed in multivariable analysis (HR 2.55, 95% CI 1.14-5.71; p=.023). Although there was no association between failure to regress and late type I or III endoleak (HR 1.50, 95% CI 0.48-4.64: p=.48), the need for late reintervention was higher for patients with failure to regress (HR 3.03, 95% CI 1.09-8.37; p=.033). Notably, all late reinterventions were percutaneous (5 main body relinings/extensions; 14 bridging-stent related; 2 coiling procedures) and did not increase mortality risk (HR 0.95, 95% CI 0.48-1.90; p=.89).
Conclusions
Aneurysm sac failure to regress at one year after f/bEVAR for TAAA is associated with worse long-term survival and increased reintervention rate. The predictive value of aneurysm sac dynamics at 1 year CTA, for adverse outcomes highlights its potential for risk stratification and guiding patient specific treatment regimen.