Benchmark Results for Physician-Modified Endografts

The term, "Physician-modified endografts (PMEGs)" was first coined by Dr Benjamin Starnes et al at the University of Washington in 2009 to extend endovascular repair to complex aortic anatomy.

A literature review was done and included studies written in the last 10 years about PMEG including current guideline statements.

PMEGs are used to extend endovascular repair to short-neck infrarenal, juxtarenal, pararenal, and thoracoabdominal aneurysms, including symptomatic or ruptured presentations as well as postdissection pathologies. Overall mortality ranges from 2-16.7% and is highly dependent on the number of rupture cases included in the study. Major adverse events have been noted between 14.6 and 30.3%. At 5 years, overall survival for PMEG patients ranges from 41-69%, likely reflecting the underlying comorbidity burden in the high surgical risk patients. In 2017, the start of PMEG implementation for aortic arch disease occurred using single fenestration for arch branches with debranching as needed. Thirty-day mortality ranged from 1-6%, with a 0-2.5% rate of in-hospital mortality, and no aneurysm-related mortality reported. Thirty-day adverse events included a 2-5% rate of stroke, a 0-1% rate of spinal cord ischemia, a 0-2% rate of retrograde dissection, and a 14-17% rate of access site complication.

Modern outcomes of PMEG use demonstrate excellent technical success, durable branch patency, and acceptable long-term survival when performed in experienced centers. Ongoing registry and investigational device exemption data will define durability, standardization, and optimal device selection across aortic segments.