Pitfalls in sizing and planning for fenestrated and branched stent-grafts in patients with chronic post-dissection thoracoabdominal aortic aneurysms.

Fenestrated-branched endovascular aneurysm repair is increasingly utilized in managing chronic post-dissection thoracoabdominal aortic aneurysms (TAAAs), with multicenter data indicating outcomes comparable to those in degenerative TAAAs. However, the anatomical and technical considerations in chronic dissection are distinct, often involving collapse of the true lumen, separate origins of target vessels from the true versus false lumen, and persistent dissection flaps extending into the renovisceral segment. Transcatheter electrosurgical septotomy is an emerging adjunct technique that aids in expanding the true lumen and optimizing proximal and distal sealing zones and branch vessel alignment during subacute and chronic post-dissection TAAA repair.

Increasing clinical experience and changes in practice protocols improved outcomes of fenestrated branched endovascular repair of complex aortic aneurysms.

Objective: To evaluate the impact of increased clinical experience and changes in practice protocols on the incidence of early major adverse events (MAEs) during fenestrated-branched endovascular aortic repair (FB-EVAR) of complex abdominal aortic aneurysms (CAAAs) and thoracoabdominal aortic aneurysms (TAAAs).

Methods: Clinical outcomes of 847 consecutive patients (72% males; median age, 74 years; interquartile range, 69-79 years) treated by the same operator in two centers were reviewed (2007-2024). Of these, 590 patients were treated under a prospective investigational device exemption study.