Large, single-center databases and the evolution of endovascular therapy for complex aortic aneurysms

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Aortic Disease Management

Background:

• Fenestrated and branched endograft repair represents a significant advancement in treating complex aortic disease.
• Long-standing programs at major centers have established large databases to evaluate this technology's application and outcomes.
• These pioneering centers have driven improvements and identified areas for future development in endovascular aortic repair.

Purpose of the Study:

• To review the evolution and outcomes of fenestrated/branched endograft repair for complex aortic disease.
• To synthesize findings from large, single-center databases to assess current status and future directions.
• To identify key challenges and areas for improvement in endovascular aortic repair.

Main Methods:

• Literature review focusing on fenestrated/branched endograft repair for complex aortic aneurysms.
• Identification and analysis of contributions from four major centers with extensive single-center databases.
• Review of studies evaluating application, perioperative outcomes, and long-term results.

Main Results:

• Endovascular treatment for complex aortic disease has progressed over 15 years, with commercialization in Europe but limited US application.
• Large centers have defined initial perioperative outcomes and identified high-risk factors like renal failure and spinal cord ischemia.
• Long-term outcome data are emerging, focusing on branch patency, renal function, and device/aortic durability.

Conclusions:

• Endovascular repair for complex aortic disease, though over a decade old, is in early adoption phases.
• Future improvements in device design are expected to simplify placement and enhance both perioperative and long-term results.
• Continued research and development are crucial for wider application and improved patient outcomes in complex aortic disease management.