Physician Modification of Polytetrafluoroethylene Based Endografts for Aortic Aneurysm Repair

Abstract

Objective:

Physician-modified endografts (PMEGs) have provided an endovascular approach for repair of complex abdominal aortic aneurysms and thoracoabdominal aortic aneurysms. While the use of polyethylene terephthalate (Dacron)-based grafts is growing, we aimed to evaluate the use and outcomes of a polytetrafluoroethylene (PTFE)-based system for such cases.

Materials and Methods:

In a retrospective, single-center cohort study from November 2021 to June 2024, treatment with physician-modified PTFE endograft for complex abdominal aortic aneurysms and thoracoabdominal aortic aneurysms was assessed. Stent modification and deployment was described and illustrated. Patient demographics, procedural details, and postoperative outcomes were collected and analyzed. Major adverse events, 30-day mortality, reintervention, endoleak, and aortic related mortality were analyzed in this cohort.

Results:

Twenty-nine patients who received physician modified PTFE endograft were included in this study. Of these patients, 25 had urgent or emergent indication for intervention. Of the grafts modified, 83% were conformable thoracic stent graft devices and 17% were excluders. Endoleaks were observed in 24.1% of patients postoperatively; 1 patient had a type 1C endoleak and 6 patients had type 2 endoleak. Reinterventions were necessary in 3 patients. The 30-day survival observed in this study was 96.6% and freedom from total aortic related mortality was 93.1%.

Conclusions:

PTFE-PMEG can be employed with limited risk of endoleak and aortic related mortality. Further study involving long-term follow up and prospective data is necessary.

Clinical Impact

PMEGs are increasingly utilized for patients unfit for open repair of complex abdominal aortic aneurysms and thoracoabdominal aortic aneurysms. Our study provides evidence in support of PMEGs for primarily medically urgent cases of this nature. We report limited complications, including endoleak or aortic related mortality, with a median follow up of over 7 months. While most of the current literature explores the use of Dacron-based grafts for PMEG, our study explores the use of PTFE-PMEG, which provides ease of manipulation and implantation. This technique can be employed with promising outcomes and necessitates further study by other vascular surgeons.