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Outcomes Of Fenestrated/Branched EVARs With Mixed Manufacturers In A Multi-institution Review
Rohini J. Patel, MD, MPH1, Alexander D. DiBartolomeo, MD
2, Agustin Sibona, MD
1, Alyssa Pyun, MD
2, Mahmoud B. Malas, MD, MHS
1, Gregory A. Magee, MD, MSc
2, Sukgu M. Han, MD, MS
2, Andrew R. Barleben, MD, MPH
1.
1University of California San Diego, La Jolla, CA, USA,
2University of Southern California, Los Angeles, CA, USA.
OBJECTIVES:
Fenestrated/branched endovascular aneurysm repairs (f/bEVAR) are increasing due to identification of complex thoracoabdominal aneurysms and failure of previous EVARs. This led to repairs incorporating endografts from multiple manufacturers due to anatomic constraints or distinct device features. Our goal was to compare outcomes between single manufacturer aortic endografts versus mixed manufacturer.
METHODS: This was a multi-institutional retrospective review of patients who underwent f/bEVAR between 2015-2022 at two tertiary centers with Investigational Device Exemption protocols for physician modified endografts (PMEG). Patients were stratified by PMEG with different versus same manufacturer for the bifurcated or proximal piece. Primary outcomes were type 3a endoleak (EL) and reintervention. Secondary outcomes included intraoperative variables and postoperative complications. We performed multivariate linear regression, Kaplan-Meier and log-rank test.
RESULTS: 319 patients with f/bEVAR were included: 237 (74.3%) cases performed with mixed manufacturer (MM) stent grafts and 82 (25.7%) with a single manufacturer (SM). MM had a greater proportion of prior EVAR (31.2% versus 15.9%, p=0.007), however, there was no difference in aneurysm size (MM: 68.6 versus SM: 66.8mm, p=0.370), aneurysm type or demographics. There was no difference in type 3a EL (MM: 3.6% versus SM 7.8%, p=0.123, Figure 1) with 100% type 3a EL reintervention in the MM and 66.7% in the SM group. Secondary outcomes revealed a longer operative time (48 minutes, p=0.001), fluoroscopy time (20 minutes, p<0.0001), and contrast volume (46cc, p<0.0001) in the SM group. There was no difference in 30-day complications or mortality.
CONCLUSIONS: This multi-institution study demonstrates f/bEVARs with multiple manufacturer stents have no increase in type 3a EL, 30-day complications or mortality. Additionally, taking advantage of graft characteristics from different manufacturers improves operative time, fluoroscopy time, and minimizes contrast.
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