title: Standard off-the-shelf versus custom-made multibranched thoracoabdominal aortic stent grafts.
abstract: OBJECTIVE
  The complex aortic branch anatomy in thoracoabdominal aortic aneurysms (TAAAs) and pararenal aortic aneurysms (PRAAs) presents a challenge for endovascular repair. The multibranched endovascular device has durable midterm results with use of a custom branch stent graft (CSG) configuration. The midterm results with use of the standard branch stent graft (SSG) configuration are unknown, but it has the advantage of off-the-shelf technology. The goal of this study was to compare the midterm outcomes of CSG and SSG multibranched endovascular devices.
  
  
  METHODS
  From July 2005 to September 2014, 133 patients underwent elective endovascular repair of TAAA and PRAA in a prospective trial. Beginning in December 2008, SSGs were used in those with suitable anatomy.
  
  
  RESULTS
  Fifty patients (mean age, 71 ± 7 years; 11 women [22%]) were treated using SSGs, and 83 patients (mean age, 74 ± 9 years; 22 women [26.5%]) underwent repair using CSGs. The SSG and CSG groups were similar with regard to aneurysm size, aneurysm extent, and medical comorbidities, with the sole exception of lung disease, which was more common in the SSG group. All stent grafts were deployed as intended, with no conversions to open repair. Mean ± standard deviation follow-up (days) was 694 ± 525 for the SSG group and 942 ± 764 for the CSG group (P = .045). There were no significant differences in aneurysm-related death, renal failure requiring dialysis, stroke, endoleak, visceral or renal branch occlusion, lower extremity weakness, or reintervention (P > .05 for each). The volume of contrast material was significantly lower in those with SSGs compared with CSGs (P = .016), but there were no significant differences in operative or fluoroscopy times. Time to treatment (days from consent to surgery) was significantly lower in SSG patients compared with CSG patients (P = .01).
  
  
  CONCLUSIONS
  For patients with suitable anatomy, the use of SSGs for TAAA and PRAA repair results in significantly shorter wait times to surgery and is as safe, effective, and durable in the midterm compared with CSGs.
authors.affiliation: Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, Calif. Electronic address: charlene.fernandez@ucsf.edu.
authors.forename: Charlene C
authors.initials: CC
authors.lastname: Fernandez
authors.affiliation: Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, Calif.
authors.forename: Julia D
authors.initials: JD
authors.lastname: Sobel
authors.affiliation: Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, Calif.
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Gasper
authors.affiliation: Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, Calif.
authors.forename: Shant M
authors.initials: SM
authors.lastname: Vartanian
authors.affiliation: Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, Calif.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Reilly
authors.affiliation: Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, Calif.
authors.forename: Timothy A M
authors.initials: TA
authors.lastname: Chuter
authors.affiliation: Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, Calif.
authors.forename: Jade S
authors.initials: JS
authors.lastname: Hiramoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011474:Prosthesis Design; D012495:San Francisco; D015607:Stents; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome