Evaluation of STaged Endovascular Aneurysm Repair in the Management of Thoracoabdominal Pathology by Means of Branched and Fenestrated Devices.(STEAR)

Since the development of custom-made fenestrated and branched endografts a novel therapeutic option for the management of thoracoabdominal aortic aneurysms was made accessible. In order to achieve complete aneurysm exclusion more than one endovascular graft is usually needed according to device characteristics and aneurysm extent. Usually a straight tube graft is initially placed in the proximal descending aorta, followed by a custom-made device for the visceral abdominal aorta, and completed with a bifurcated infrarenal graft landing at the level of the common iliac arteries. Many variations are available according to patient anatomy, pathology, and previous aortic surgeries.

The different components required can be deployed in the patient in one setting (i.e. single-stage endovascular repair) or across more than one surgeries (i.e. multi-stage endovascular repair), depending on procedural needs and surgeon choice. According to limited reported series the latter option seems to be associated to better clinical outcomes both in terms of spinal cord ischemia and overall survival.

In addition to the number, type and order of stages required for patient treatment, primary and secondary end-points are the evaluation of the short-term (6 months) and mid-term (5 years) outcomes as illustrated in the Society for Vascular Surgery reporting standards for TEVAR.

The investigators review a prospectively compiled Microsoft Office Excel database with the procedural details of the 47 patients treated at our Institution between October 2013 and October 2017 by means of total endovascular thoracoabdominal aortic aneurysm repair and of those of the next 50 patients which will be treated until December 2020. All patients will be recorded together with their characteristics and number and type of stages required for treatment completion.

All enrolled patients will be contact yearly by phone, in addition to standard follow-up imaging, to confirm persistence of technical and clinical success and to evaluate the eventual onset of any treatment related complication or disease evolution Possible stage types will be differentiated as: proximal thoracic component (TEVAR), visceral component (Custom-Made), bifurcated component (EVAR), iliac extensions, iliac branch devices.