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Textbook Outcomes Following Fenestrated-branched Endovascular Aortic Repair - A Prospective Non-randomized Cohort Study
Hannah Victoria Oden-Brunson, MD1, Ying Huang, MD PhD
1, Bruno Pagnin Schmid, MD
1, Zemia M. Camara Costa Ferreira, MD
1, Steven Maximus, MD
1, Jorge Miranda, MD
1, Erin Greenleaf, MD
1, Naveed Saqib, MD
2, Thanila A. Macedo, MD
1, Manju Kalra, MBBS
3, Gustavo S. Oderich, MD
1.
1Baylor College of Medicine, Houston, TX, USA,
2The University of Texas Health, Houston, TX, USA,
3Mayo Clinic, Rochester, MN, USA.
OBJECTIVES: Fenestrated-branched endovascular aortic repair (FB-EVAR) has been increasingly utilized to treat complex aortic aneurysms (CAAs). The term ‘Textbook Outcome’ (TO) was coined to describe a composite metric of desired postoperative outcome as a measure of quality of care. The aim of this study was to evaluate TOs achieved following FB-EVAR for treatment of CAAs and to identify risk factors of failure to achieve a TO.
METHODS: We reviewed the clinical data of consecutive patients enrolled in a prospective, non-randomized physician sponsored investigational device exemption study to assess FB-EVAR for treatment of complex abdominal (CAAAs) and thoracoabdominal aortic aneurysms (TAAAs) between 2013 and 2025. TO was defined as a composite outcome including absence of major complications, early reintervention, prolonged hospital length of stay (LOS, based on the 75th percentile of the cohort), non-home hospital discharge and death within the 1st year. Primary endpoint was incidence of TO and independent predictors for failure to achieve TO following FB-EVAR.
RESULTS: A total of 609 patients (422 [69%] males, mean age 73.2±8.6 years-old) were studied. Aneurysm extent was CAAA in 165 (27%) patients and TAAA in 444 (73%). Early mortality was 1.1% (n=7). TO was achieved in 373 patients (61%), including absence of major complications in 514 patients (85%), no early reintervention in 552 (91%), no prolonged LOS in 465 (76%), discharge to home in 529 (87%), and 1 year survival in 559 (92%). Independent predictors of failure to achieve TO on multivariable analysis (
Figure 1) were female sex (p=.002), age (p<.001), COPD (p=.006), family history of aortic disease (p=.047), chronic post-dissection aneurysms (p=.044), and larger aneurysm (p=.004).
CONCLUSIONS: FB-EVAR was performed with low (1.1%) early mortality and with a TO achieved in nearly two out of three patients. The largest barriers to achieve TO were major complications and prolonged LOS. Female sex, age, COPD, family history of aortic disease, chronic post-dissection aneurysms and larger aneurysms were independently associated with failure to achieve TO. This data provides a benchmark to guide initiatives to improve rates of TO in order to mitigate complications and early reinterventions in at risk patients.
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