Multicentre retrospective analysis of physician-modified fenestrated/inner-branched endovascular repair for complex aortic aneurysms

In this multicentre retrospective observational study, we present the early outcomes of physician-modified fenestrated/inner-branched endovascular repair for pararenal and thoracoabdominal aortic aneurysms in patients at high risk for open surgical repair. We comprehensively reviewed the clinical data and outcomes of consecutive patients treated with physician-modified fenestrated/inner-branched endovascular repair for pararenal or thoracoabdominal aortic aneurysms at 6 centres between December 2020 and December 2021. Primary end-points included technical success, in-hospital mortality rates, major adverse events. Seven and 31 patients (median age, 80.5 years) had pararenal and thoracoabdominal aortic aneurysms, respectively, involving 93 renal-mesenteric arteries incorporated through 10 fenestrations or 83 inner branches. Seven patients (18.4%) were treated non-elective conditions. The technical success rate was 89.5%. The median operative time was 334.5 min. Ten patients (26.3%) experienced major adverse events, including in-hospital mortality in 6 patients (15.8%), acute kidney injury in 3 patients (7.9%), respiratory failure in 3 patients (7.9%), bowel ischaemia in 1 patient (2.6%), stroke in 1 patient (2.6%) and paraplegia in 1 patient (2.6%). Among elective cases, in-hospital deaths occurred in 3 patients (9.7%), while in non-elective cases, the mortality rate was higher, with 3 patients (42.9%) succumbing. The median follow-up duration was 14 months. Physician-modified fenestrated/inner-branched endovascular repair is a viable treatment for pararenal or thoracoabdominal aortic aneurysms in patients at high risk for open surgical repair. It provides customization without location constraints or production delays, but further validation is needed to ensure long-term reliability.