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Characterizing Off-ifu Pmeg Utilization; An Analysis Of Online Bibliographic Databases And Social Media Platform X
Robert Tatum
1, Dawn Salvatore, MD
2, Michael Nooromid, MD
2, Paul DiMuzio, MD
2, Babak Abai, MD
2.
1University of Vermont Medical Center, Winooski, VT, USA,
2Thomas Jefferson University Hospital, Philadelphia, PA, USA.
OBJECTIVES: To characterize the present landscape of PMEG utilization and the impact of an institution's investigational device exemption (IDE) status on endograft use by analyzing publication trends and social media coverage.
METHODS: We used social media platform X and three reputable online bibliographic databases (Pubmed, Medline, SCOPUS) to perform a keyword search utilizing the following terms: PMEG; physician-modified endograft; and laser fenestration. Data extracted from X and online articles included authorship, IDE protocol status, pertinent clinical outcome measures, and more. An internet search was performed to determine which affiliate institutions were performing PMEG through an IDE protocol. Institutions without a documented IDE protocol were classified as off-IFU. Data comparison was performed using standard methods.
RESULTS: Our search identified 177 X posts and 315 published articles between the years 2017 and 2024. 61% (109/177) of X post authors were male and the most frequently mentioned device was Cook (n=21) followed by Gore (n=12) and AFX (n=2). IDE was mentioned in 3.9% (7/177) of X posts. 67% (119/177) of posts mentioned a thoracoabdominal repair compared to 18% (32/177) arch and 15% (26/177) did not indicate repair type. Of the 74 posts mentioning number of branch grafts, 35% (26/74) were three-branch, and 65% (48/74) were four-branch repairs. 64% (114/177) of X posts were related to procedural technique followed by 20% (34/177) meeting presentation, 14% (n=24) education, and 2% (n=5) mentorship.The most frequently observed complication was endoleak (n=8) followed by aneurysmal degeneration (n=3) and stent migration (n=1). Among the included 315 online articles, most author institutions were academically affiliated (n=236) and geographically urban (n=209). Of the 274 articles for which author training history was available, most training institutions were in the United States (n=238) and urban (n=211). The most frequently reported outcome measure was endoleak (n=249), followed by need for reintervention (n=199), stent migration (n=57), and aneurysmal degeneration (n=41). Only 31% (97/315) of articles documented an IDE and the remaining 69% (218/315) were classified as off-IFU. Of the 144 articles indicating commercial device utilization, Cook was the most frequently reported platform (n=97) followed by Gore (n=47).
CONCLUSIONS: Physician-modified endografting is an adopted technique for the treatment of anatomically complex thoracoabdominal aortopathologies and many centers are performing PMEG off-IFU without an IDE.
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