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Outcomes Of Physician-modified Endografts For Emergent And Urgent Repair Of Complex Aortic Aneurysms
Carter Colwell, MD, Cole Pieroni, BA, Marisa Doran, MD, Bernard Boateng, DO, Esmaeel Dadashzadeh, MD, Joshua Adams, MD.
Carilion clinic, Roanoke, VA, USA.

Objectives: To evaluate outcomes following urgent or emergent repair of thoracoabdominal aortic aneurysms (TAAA) and pararenal aortic aneurysms (PRA) using physician-modified endografts (PMEG).
Methods: A retrospective review was conducted at a single center of all patients who underwent endovascular repair for symptomatic, impending rupture, or ruptured PRA and TAAA using a PMEG from May 1, 2017, to July 1, 2025. Cases were deemed emergent if performed in under 24 hours after admission and urgent if performed within 1 week of hospital admission. The primary outcome was in-hospital mortality. Secondary outcomes included major adverse events such as spinal cord ischemia, myocardial infarction, acute kidney injury, bowel ischemia, and the need for secondary interventions.
Results: A total of 43 (35 male, mean age 71.51 years) patients who underwent fenestrated endovascular aortic repair (FEVAR) with PMEG were identified (Table 1). Nineteen patients underwent urgent repair for symptomatic aneurysms, and 24 patients underwent emergent repair for ruptured or contained rupture. The procedure details included an average aneurysm diameter of 69.33 mm, back-table modification time of 68.8 minutes, procedure duration of 227.52 minutes, average of 3.35 fenestrations per procedure (Table 1). Thirty-day all-cause mortality was 7% (3 patients). At one-year, overall survival was 77%, and at three years, survival was 55%.
Conclusions: Emergent or urgent repair of complex abdominal aortic aneurysms using PMEG is safe and technically successful in patients with suitable anatomy. These results suggest that PMEG should be considered a viable option for patients requiring emergency repair, especially in regional tertiary Aortic Centers where graft modification can begin during patient transit. Emphasizing appropriate surveillance strategies could reduce the increased mortality associated with emergent repairs by facilitating elective interventions.
Table 1 Patient Demographics, Procedural Characteristics, and Outcomes Following Urgent and Emergent PMEG Repair of Complex Aortic Aneurysms

	Total Number of Patients		N=43
	Male		35 (81%)
	White		40 (93%)
	Age (years)		71.51 ± 9.4
	Transferred from outside hospital		28 (65%)
	Aneurysm Diameter (mm)		69.33 ± 18.5
	Symptomatic		19 (44%)
	Impending/Contained Rupture		21 (46.5%)
	Free Rupture		3 (7%)
	Modification Duration (min)		68.77 ± 27.8
	Procedure Duration (min)		227.57 ± 114.2
	Total Fenestrations		N=145
	Celiac		29 (20%)
	SMA		40 (28%)
	Renal		72 (50%)
	Accessory Renal		2 (1%)
	Technical Success		98%
	Total Length of Stay (days)		4.93 ± 5.49
	In-hospital mortality		2 (5%)
	1-year mortality		7 (23%)
	3-year mortality		9 (45%)
	Major Adverse Events		28 (65%)
	Early Re-intervention (within 30 days)		6 (14%)
	Total Re-interventions		13 (24%)
	Average Time to Re-intervention (days)		339.1 ± 506.9
	Median Follow up (days)		574.4 ± 651.5

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