High Technical Success and Low Re-Intervention Rate of Physician-Modified Endografts for Reno-Visceral Aortic Pathologies: Systematic Review and Meta-Analysis

Abstract

Background:

The objective of this systematic review was to provide evidence-based data regarding the safety and efficacy of physician-modified endografts (PMEGs) for reno-visceral aortic pathologies.

Methods:

A systematic search of all the literature reported until February 2025 was performed according to the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. The main outcomes were technical success, major adverse events (MAE), mortality, bridging stents instability, device related re-intervention and type Ic/IIIc endoleak.

Results:

A total of 273 study titles were identified by the initial search strategy, of which 19 studies were considered eligible for inclusion in the meta-analysis. A total of 1585 patients (78%, male) were identified among the eligible studies. The median follow-up of the included studies was 14 months (ranged from 5 to 47 months). The overall technical success rate was 98.1% (95% CI 97.2%-98.8%, p<0.75, I²=0%)(98.6% in elective cases, 95.1% for emergent/urgent cases). The overall MAE was 24.3% (95% CI, 19.1%-30.4% p<0.00, I²=81%;) (elective group: 22.2%; emergent/urgent: 26%). The pooled 30-day mortality rate was 6.1% (95% CI 4.3%-8.6%, p=0.002, I²=55%) (elective group: 4.8%; emergent/urgent: 15.6%). The pooled rate of early device-related re-intervention rate was 9.5% (95% CI 5.6%-15.7%, p=0.00, I²=85%) (elective group: 8.9%; emergent/urgent:10.5%). The overall late pooled device-related re-intervention rate was 13.9% (95% CI 8.1%-22.8%, p=0.00, I²=91%) (elective group: 14.6%; emergent/urgent: 15.6%). The pooled bridging stents instability during the early period was 1.9% (95% CI 1.1%-3.2%, p=0.00, I²=80%). The late pooled late bridging stents instability was 1.5% (95% CI 1.1%-3.2%, p=0.00, I²=74%).

Conclusions:

Physician-modified endografts represent a favorable alternative for treatment of reno-visceral pathologies. High technical success rate, low 30-day mortality and low re-intervention rate makes it an attractive solution for use in daily clinical practice. However, randomized studies with custom-made devices, larger sample sizes, and long-term follow-up are crucial for more robust and detailed analysis.

Clinical Impact

This study provides detailed information on a physician-modified endografts for omplex endovascular treatemnt. As the custom-made endografts have been developed, the delivery time for them varies between countries and vascular surgery services, making the planning of the procedure difficult, especially in symptomatic patients with complex abdominal aortic aneurysms. The objective of this systematic review was to provide evidence-based data regarding the safety and efficacy of the physician-modified endografts (PMEGs) for complex endovascular treatment. Overall the results suggest that PMEGs represent a favourable alternative for complex endovascular treatment. High technical success rate, low 30-day mortality and low re-intervention rate makes it an attractive solution for use in daily clinical practice.