VESS08 - A fast-track staged approach in elective fenestrated/branched endovascular repair of thoracoabdominal aortic aneurysms is safe and effective.

Wednesday, June 10, 2026

2:39 PM - 2:44 PM ET

Location: Hynes CC, Third Level, Room 304

Presenting Author only(s)

Andrea Vacirca, MD, PhD (he/him/his)

Vascular Surgeon
University of Bologna
Bologna

Co-Author(s)

Enrico Gallitto, MD, PhD

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

Co-Author(s)

AC

Antonio Cappiello
Gianluca Faggioli, MD, PhD

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

Pietro Fiorio

Univeristy of Bologna
SC

Stefania Caputo

Emilia-Romagna, Italy
PS

Paolo Spath

Vascular Surgeon, University Researcher
Department of Vascular Surgery, S. Orsola-Malpighi University Hospital, Bologna, Italy.
BOLOGNA, Emilia-Romagna, Italy
Rodolfo Pini, MD, PhD

University Researcher
Vascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
Bologna, Italy
FC

Federica Campana

Vascular Surgery Resident, PhD Candidate
Vascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
Bologna, Emilia-Romagna, Italy

Senior Author(s)

MG

Mauro Gargiulo

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

Objectives: Staged repair of thoracoabdominal aortic aneurysms (TAAAs) has been proposed as an effective strategy to reduce spinal cord ischemia (SCI) in fenestrated/branched endovascular aortic repair (F/B-EVAR). However, inter-step intervals up to 3 months and aortic-related complications of 13% have been reported.1 A fast-track staged approach could mitigate complications arising in the lead period but increase the incidence of SCI. The aim of this study was to report the outcomes of a fast-track staged approach for elective and urgent TAAAs in F/B-EVAR.

Methods: This was a single-center, retrospective analysis of patients who underwent staged F/B-EVAR between 2016 and 2025. A fast-track staged approach was defined as complete TAAA exclusion within 30-day from the index procedure. Symptomatic patients or those presenting with contained TAAAs rupture were considered urgent. Outcomes were reported according to the Society for Vascular Surgery reporting standards. Interval aortic adverse events (IAEs - rupture, symptoms, unexplained deaths), SCI and 30-day/hospital mortality were evaluated.

Results: Out of 412 F/B-EVAR cases, 156(38%) were managed using a staged approach (elective: 131-84%; urgent: 25-16%). There were 109(70%) Crawford’s extent I-III TAAAs and 76(48%) previous aortic repairs. The different staging techniques are summarized in Table I. The median time between the first and last stage and hospitalization was 13+2 and 20+1 days, respectively. One hundred and forty-one (92%) cases were managed within 30 days: 5-7 days - 62%; 8-15 days - 28%; 16-30 days - 10%. Three (2%) patients died between stages including 1(0.6%) aortic rupture 2 days after the index procedure (symptomatic TAAAs); this was the only IAE observed. Overall, 7(5%) patients died within 30-day (including inter-step mortality). Out of 15(10%) SCI events, there were 10(6%) permanent cases with 2(1%) paraplegia. There was no difference between cases managed within 5-7 days and > 30-day (SCI: 3% vs 8%; P:0.4). In elective Crawford’s extent I-III TAAAs, 30-day mortality, SCI and paraplegia were 2%, 3% and 1%, respectively. In urgent setting, these values increased to 15%, 25% and 5%, respectively. Urgent setting was determinant of SCI (OR:15; 95% CI:3-90; P:.003). Permanents SCI was determinant of 30-day/hospital mortality (OR:20; 95% CI:3-117; P: .001).

Conclusions: A fast-track staged approach for elective TAAAs in F/B-EVAR appears to be safe and effective with low rates of IAEs, SCI and 30-day/hospital mortality. In urgent setting, SCI and mortality remain noteworthy and should be carefully weighed during patient selection and treatment planning. The cost/effectiveness of prolonged hospitalization should be evaluated.