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Journal Article Ahead of print

PubMed: 42285180 DOI: 10.1016/j.jvs.2026.04.033

Postdissection thoracoabdominal aortic aneurysm presenting with narrow true lumen: Outcomes after fenestrated and branched endovascular repair from the international multicenter NArrow-true-lumen DIssection Registry (NADIR) study group.

J Vasc Surg

Authors: Michele Piazza, Simona Marrocco, Tilo Kölbel, Nikolaos Tsilimparis, Stephan Haulon, Gustavo S Oderich, Andres Schanzer, Germano Melissano, Andrea Kahlberg, Martin Austermann, Marco V Usai, Kevin Mani, Giovanni Pratesi, Mauro Gargiulo, Enrico Gallitto, Michel J Bosiers, Gian Franco Veraldi, Luca Mezzetto, Luca Bertoglio, Raffaele Pulli, Wassim Mansour, Nuno Dias, Daniela Branzan, Gianbattista Parlani, Rocco Giudice, Ciro Ferrer, Kak Khee Yeung, Giovanni Tinelli, Yamume Tshomba, Fiona Rohlffs, Roberto G Aru, Bijan Modarai, Mohamed Abdelhalim, Petroula Nana, Giuseppe Panuccio, Giorge Apostolidis, Bruno Schmid, Sara Medina, Gioele Simonte, Giacomo Isernia, Martina Bastianon, Andrea Melloni, Pietro Dioni, Nicola Favia, Kaj Kappe, Erin Salicilar, Yasir Mohammed, Marton Berczeli, Cristoph Knappich, Angelos Karelis … and 8 other authors

Affiliations

  • Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
  • Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
  • German Aortic Centre Hamburg, Department of Vascular Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Department of Vascular Surgery, University Hospital LMU Munich, Munich, Germany.
  • Aortic Center, Hôpital Marie Lannelongue, GHPSJ, Le Plessis-Robinson, France.
  • Advanced Endovascular Aortic Research Program, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
  • Department of Vascular and Endovascular Surgery, University of Massachusetts Chan Medical School, Worcester, MA.
  • Department of Vascular Surgery, San Raffaele Scientific Institute, Vita-Salute University, Milano, Italy.
  • Department of Vascular and Endovascular Surgery, St. Franziskus Hospital Münster, Munster, Germany.
  • Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden.
  • Vascular and Endovascular Surgery Unit, Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy.
  • Vascular Surgery Unit, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Bologna, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
  • Department of Vascular Surgery, University Hospital Bern, University of Bern, Bern, Switzerland.
  • Vascular Surgery, Integrated University Hospital of Verona, Verona, Italy.
  • Division of Vascular Surgery, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy.
  • Vascular Surgery Department, Careggi University Hospital, University of Florence, Florence, Italy.
  • Department of Vascular Surgery, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy.
  • Vascular Center, Department of Thoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.
  • Department of Vascular and Endovascular Surgery, Technical University of Munich, University Hospital Rechts der Isar Munich, Munich, Germany.
  • Unit of Vascular and Endovascular Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy.
  • Vascular and Endovascular Surgery Unit, San Giovanni Addolorata Hospital, Rome, Italy.
  • Department of Surgery, Amsterdam University Medical Centers, Location University of Amsterdam, Amsterdam, The Netherlands.
  • Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS Università Cattolica del Sacro Cuore, Rome, Italy.
  • Department of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany.
  • Aortic Center, Hôpital Marie Lannelongue, GHPSJ, Le Plessis-Robinson, France; Division of Vascular and Endovascular Surgery, Department of Surgery, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, PA.
  • Academic Department of Vascular Surgery, South Bank Section, School of Cardiovascular and Metabolic Medicine & Sciences, BHF Centre of Excellence, King's College London, London, UK.

Abstract

BACKGROUND

The impact of a narrow true lumen (NTL) on the outcomes of fenestrated-branched endovascular repair in patients with postdissection thoracoabdominal aortic aneurysms (PD-TAAAs) is underreported.

METHODS

Data from an international, multicenter registry were analyzed, to identify patients treated for PD-TAAAs (2015-2025) at 23 centers. All patients underwent fenestrated-branched endovascular repair using custom or off-the-shelf endografts. NTL was defined by a true lumen diameter <25 mm identified at any aortic level on preoperative computed tomography angiogram. Short-term endpoints compared between NTL and no-NTL patients included technical success, procedural metrics, 30-day mortality, and major adverse events (MAEs). Midterm endpoints included 5-year freedom from aortic adverse events (related mortality, rupture, reintervention, endograft instability) and freedom from target artery instability.

RESULTS

Among 544 patients (1705 target vessels), 438 (80%) had an NTL. Device design did not differ between groups (52% branches, 30% fenestrated, and 18% fenestrated-branched combination; P = .053). Patients with an NTL more frequently received bridging stent reinforcement (P < .001), and renal inner branches (P = .038). Septotomy or false lumen occlusion were more often performed in NTLs (27% vs 11%; P = .006). Patients with NTLs had longer operating time (P = .031), fluoroscopy time (P = .007), and a higher dose area product (P = .046). Technical success was 95% in both groups (P = .750). Overall 30-day mortality was 4%, and MAEs occurred in 35%. NTLs did not have a significant impact on MAEs (adjusted odds ratio, 0.84; 95% confidence interval [CI], 0.28-2.76; P = .766). Freedom from any aortic adverse event at 5 years was lower in patents with NTL (73% vs 91%; P = .027), driven primarily to secondary procedures of false lumen embolization (P = .027). Freedom from target vessel instability was 86% ± 4% in the NTL group and 92% ± 4% in the no-NTL group (P = .072). Patients with NTLs had a similar primary patency (97% ± 2% vs 98% ± 2%; P = .380) but lower freedom from target vessel endoleak (89% ± 4% vs 97% ± 3%; P = .006). After adjustment, NTL diameter <10 mm (hazard ratio [HR], 2.45; 95% CI, 1.37-4.36; P = .002) was significantly associated with target artery instability. Use of inner branches (HR, 0.11; 95% CI, 0.02-0.87; P = .035) and bridging stent reinforcement (HR, 0.54; 95% CI, 0.31-0.96; P = .038) were protective.

CONCLUSIONS

NTL is the most common anatomic presentation in PD-TAAAs and is associated with more complex procedures, but does not affect technical success, mortality, or MAEs. Patients with am NTL experience a higher rate or reinterventions, primarily false lumen embolization. NTL <10 mm is a risk factor for target vessel instability, and reinforcement of bridging stents may be beneficial in these cases.

MeSH

Registries, Stents, Aortic Aneurysm, Mortality, Reinforcement, Psychology, Aneurysm, Arteries, Drug-Related Side Effects And Adverse Reactions, Dissection, Aortic Aneurysm, Thoracoabdominal, Recipient Vessels