Physician-Modified Fenestrated Stent-Grafts Planned Using Three-Dimensional Techniques for Complex Aortic Pathology:...

Area of Science:

• Vascular Surgery
• Medical Imaging
• Interventional Cardiology

Background:

• Complex aortic pathology involving visceral arteries poses significant therapeutic challenges.
• Open repair carries high perioperative risks, especially in comorbid patients.
• Standard EVAR is often limited by inadequate sealing zones, necessitating advanced techniques.

Purpose of the Study:

• To evaluate the effectiveness and safety of physician-modified stent-grafts (PMSG) planned with three-dimensional (3D) techniques.
• To analyze technical success, target vessel patency, early mortality, endoleak, and reintervention rates.
• To assess PMSG as a pragmatic alternative to custom-made fenestrated and branched endovascular repair (F/BEVAR).

Main Methods:

• Systematic search of PubMed/MEDLINE and Embase databases.
• Inclusion of studies using physician-modified fenestrated stent grafts planned with 3D tools.
• Meta-analysis using a random-effects model with logit transformation for proportions.

Main Results:

• Analysis of five studies with 172 patients; mean follow-up of 14.9 months.
• High technical success rate (92.9%) and target vessel patency (96.9%).
• Early mortality was 5.5%, endoleak incidence was 13.3%, and reintervention rate was 6.6%.

Conclusions:

• PMSG procedures planned with 3D techniques demonstrate high technical success and preserved target vessel patency for complex aortic pathology.
• Variability in endoleak and reintervention rates may stem from anatomical complexity and patient selection.
• Further prospective studies are warranted to validate long-term outcomes.