Clinical outcomes of spinal cord ischemia after fenestrated and branched endovascular stent grafting during total endovascular aortic repair for thoracoabdominal aortic aneurysms

Abstract Purpose In this single-center study, we assessed the clinical outcomes of fenestrated-endovascular aortic repair (f-EVAR) and branched EVAR on morbidity and mortality during total endovascular aortic repair for thoracoabdominal aortic aneurysms (TAAAs). Methods Between July 2006 and June 2015, elective f-EVAR and multibranched EVAR (t-Branch) for TAAAs were performed in 99 patients at our institution [Crawford classification types I (7), II (13), III (6), IV (55), and V (18)]. We retrospectively analyzed 44 patients, excluding those with Crawford type IV TAAAs, and compared 30 patients treated with f-EVAR and 14 treated with t-Branch. Multivariate analysis was performed to determine the factors associated with perioperative spinal cord ischemia (SCI). Results Technical success was 96.7% with f-EVAR and 100% with t-Branch, and the 30-day mortality rate was 3.3% with f-EVAR and 7.1% with t-Branch ( P = 0.646). The incidences of perioperative SCI were higher with t-Branch (n=5, 35.7%) than those with f-EVAR (n=2, 6.7%) ( P = 0.04). Endoleaks were more prevalent with f-EVAR (n=9, 30.0%) than with t-Branch (n=1, 7.1%) ( P = 0.046). Rates of freedom from aneurysm-related death after 1 year for f-EVAR and t-Branch were 96.7 and 92.9%, respectively, and those after 3 years were 88.8 and 92.9% ( P = 0.982), respectively. The risk of SCI remarkably increased in the presence of risk factors such as procedure (t-Branch), maximum short axis of ≥65 mm, coverage length of ≥360 mm, internal iliac artery occlusion, and ≥5 sacrificed intercostal arteries. Conclusions Our initial to mid-term results of f-EVAR and t-Branch were good with low rates of perioperative mortality and high rates of freedom from aneurysm-related death. SCI incidence with t-Branch was significantly high; it is important to develop additional SCI prevention methods for patients with high-risk factors.