SS11 - Effect of narrow true lumen on the outcomes of fenestrated-branched endovascular repair of post-dissection thoracoabdominal aneyrysms: results from a multicenter international registry

Friday, June 12, 2026

8:41 AM - 8:52 AM ET

Location: Hynes CC, Third Level, Ballroom B

Presenting Author only(s)

Michele Piazza, MD (he/him/his)

University of Padova
Padova

Co-Author(s)

TK

Tilo Kölbel, MD, PhD

Vascular Surgeon
German Aortic Center, Department of Vascular Medicine, University Heart and Vascular Center UKE Hamburg
Hamburg, Germany
Stephan Haulon, MD, PhD

Professor
Université Paris-Saclay
Paris, France
GO

Gustavo Oderich

Professor of surgery
Michael E. DeBakey Department of Surgery, Division of Vascular and Endovascular Surgery, Baylor College of Medicine, Houston, TX
GP

Giovanni Pratesi

Department of Surgical and Integrated Diagnostic Sciences, University of Genoa, Genoa, Italy
MG

Mauro Gargiulo

Ordinary Professor
Vascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
Bologna
YT

Yamume Tshomba

Italy
Kak Khee Yeung, MD, PhD

Noord-Holland, Netherlands
MA

Martin Josef Austermann

Director Clinic for vascular surgery and phlebology
St. Franziskus Hospital
Muenster, Nordrhein-Westfalen, Germany
NT

Nikolaos Tsilimparis

Chief of Vascular Department
LMU University Hospital Munich
Munich, Germany
MB

Michel J. Bosiers, MD

MD
St. Franziskus Hospital
Muenster, Switzerland
ND

Nuno Dias

Sweden
Kevin Mani, PhD

Uppsala University
Uppsala, Sweden
Michele Antonello, MD, PhD

Professor of Vascular Surgery
Vascular Surgery – Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua Faculty of Medicine and Surgery; Padua
Padua, Veneto, Italy

Submitting Author only(s)

Francesco Squizzato, MD

Assistant Professor
Vascular Surgery – Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua Faculty of Medicine and Surgery; Padua
Padova, Veneto, Italy

Objectives: To assess the impact of a narrow true lumen (NTL) on the outcomes of fenestrated-branched endovascular repair (F/B-EVAR) in patients with post-dissection thoracoabdominal aortic aneurysms (TAAA).

Methods: Data from a multicenter registry were collected and analyzed, including patients treated for post-dissection TAAA (2015-2025) at 23 centers. All included patients underwent F/B-EVAR using custom or off-the-shelf endografts. NTL was defined by a TL diameter < 25 mm at any aortic level at the preoperative computed tomography angiogram. The endpoints compared between NTL and no-NTL patients were technical success, procedural metrics, 30-day mortality and major adverse events (MAEs), and 5-years freedom from aortic adverse events (related mortality, rupture, reintervention, endograft instability) and from target artery instability.

Results: Among 544 patients (1705 target vessels), 438 (80%) had a NTL. Overall, 52% of patients received a branched endograft, 30% a fenestrated, and 18% a fenestrated-branched, without differences between groups (P=.053). Patients with a 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 NTL (27% vs 11%; P=.006). Patients with NTL 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).
Thirty-day mortality was 4%, and MAE occurred in 35%. NTL did not have a significant impact on MAE (Adjusted OR, 0.84, 95%CI 0.28-2.76; P=.766).
Freedom from any aortic adverse event at 5 years was lower in NTL (73% vs 91%; P=.027), and was mostly related to secondary procedures of false lumen embolization (P=.027).
Freedom from target vessel instability was 86±4% in the NTL and 92±4% in the No-NTL (P=.072). NTL patients 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 (HR 2.45; 95%CI 1.37-4.36; P=.002) was significantly associated to 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 anatomical presentation in post-dissection TAAA and associated with more complex procedures, but does not affect technical success, mortality, or MAE. Patients with a NTL experience a higher rate or reinterventions, consisting especially in false lumen embolization, and a NTL < 10 mm is a risk factor for target vessel instability. Use of inner branches or reinforcement of bridging stents may be beneficial in these cases.