Endovascular Treatment of Thoracoabdominal Aortic Pathologies in the Fourth Segment with Branched Custom-Made Devices with a Short Proximal Sealing Zone.

BACKGROUND

Endovascular surgery plays an increasingly vital role in treating complex aortic pathologies, particularly in elderly and high-risk patients. Custom-made devices (CMDs) offer an alternative to off-the-shelf (OTS) endoprostheses, allowing for a tailored approach to aneurysm repair. This study evaluates the outcomes of CMDs with a short proximal sealing zone in the treatment of Crawford type IV thoracoabdominal aneurysms (TAAAs) and other aortic pathologies, aiming to reduce spinal cord ischemia while maintaining procedural efficacy and safety.

METHODS

A retrospective, observational study was conducted on 58 patients (54 men, 4 women) treated with CMDs from May 2019 to December 2022. Patients presented with various aortic pathologies, including Crawford type IV TAAAs and chronic dissections. The primary end points included spinal cord ischemia, 30-day mortality, and type IA endoleak occurrence. Secondary end points encompassed additional endoleaks, postimplant syndrome, graft infection, and branch patency. Statistical analysis was performed using median values with interquartile ranges for continuous variables and percentages for categorical data.

RESULTS

The mean age of patients was 71.3 years (±6.3, range 58-82 years). CMDs with four branches were most commonly used (44 patients), whereas others received three or five branches. The proximal sealing zone ranged from 32 mm to 63 mm. Spinal cord ischemia occurred in two patients (3.4%), both of whom had predisposing factors, with one achieving full neurological recovery postintervention. The 30-day mortality rate was 8.62%, with causes primarily unrelated to the aortic procedure. No cases of type IA endoleak or endograft migration were observed during follow-up. The most frequent complication was type II endoleak (40%), often resolving spontaneously. Early postoperative imaging revealed parenchymal infarctions in 34.5% of cases, although these were not clinically significant in most patients.

CONCLUSION

CMDs with short proximal sealing zones appear to be an effective and safe strategy for treating Crawford type IV TAAAs and other aortic pathologies while reducing spinal cord ischemia risk. The results suggest that CMDs may offer a viable alternative to FEVAR and OTS-branched endografts. However, long-term follow-up and comparative studies are necessary to confirm durability and effectiveness. Expanding CMDs into OTS availability could enhance their utility in urgent settings.