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Postdissection thoracoabdominal aortic aneurysm presenting with narrow true lumen: Outcomes after fenestrated and branched endovascular repair from the international multicenter NArrow-true-lumen DIssection Registry (NADIR) study group

Piazza, Michele ; Marrocco, Simona ; Kölbel, Tilo LU ; Tsilimparis, Nikolaos ; Haulon, Stephan ; Oderich, Gustavo S. ; Schanzer, Andres ; Melissano, Germano ; Kahlberg, Andrea and Austermann, Martin , et al. (2026) In Journal of Vascular Surgery p.1-15
Abstract
Background
The impact of a narrow true lumen (NTL) on the outcomes of fenestrated-branched endovascular repair in patients with postdissection thoracoabdominal aortic aneurysms (PD-TAAAs) is underreported.
Methods
Data from an international, multicenter registry were analyzed, to identify patients treated for PD-TAAAs (2015-2025) at 23 centers. All patients underwent fenestrated-branched endovascular repair using custom or off-the-shelf endografts. NTL was defined by a true lumen diameter <25 mm identified at any aortic level on preoperative computed tomography angiogram. Short-term endpoints compared between NTL and no-NTL patients included technical success, procedural metrics, 30-day mortality, and major adverse events... (More)
Background
The impact of a narrow true lumen (NTL) on the outcomes of fenestrated-branched endovascular repair in patients with postdissection thoracoabdominal aortic aneurysms (PD-TAAAs) is underreported.
Methods
Data from an international, multicenter registry were analyzed, to identify patients treated for PD-TAAAs (2015-2025) at 23 centers. All patients underwent fenestrated-branched endovascular repair using custom or off-the-shelf endografts. NTL was defined by a true lumen diameter <25 mm identified at any aortic level on preoperative computed tomography angiogram. Short-term endpoints compared between NTL and no-NTL patients included technical success, procedural metrics, 30-day mortality, and major adverse events (MAEs). Midterm endpoints included 5-year freedom from aortic adverse events (related mortality, rupture, reintervention, endograft instability) and freedom from target artery instability.
Results
Among 544 patients (1705 target vessels), 438 (80%) had an NTL. Device design did not differ between groups (52% branches, 30% fenestrated, and 18% fenestrated-branched combination; P = .053). Patients with an 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 NTLs (27% vs 11%; P = .006). Patients with NTLs 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). Overall 30-day mortality was 4%, and MAEs occurred in 35%. NTLs did not have a significant impact on MAEs (adjusted odds ratio, 0.84; 95% confidence interval [CI], 0.28-2.76; P = .766). Freedom from any aortic adverse event at 5 years was lower in patents with NTL (73% vs 91%; P = .027), driven primarily by secondary procedures of false lumen embolization (P = .027). Freedom from target vessel instability was 86% ± 4% in the NTL group and 92% ± 4% in the no-NTL group (P = .072). Patients with NTLs 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 (hazard ratio [HR], 2.45; 95% CI, 1.37-4.36; P = .002) was significantly associated with 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 anatomic presentation in PD-TAAAs and is associated with more complex procedures, but does not affect technical success, mortality, or MAEs. Patients with an NTL experience a higher rate or reinterventions, primarily false lumen embolization. NTL <10 mm is a risk factor for target vessel instability, and reinforcement of bridging stents may be beneficial in these cases. (Less)
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organization
publishing date
type
Contribution to journal
publication status
epub
subject
in
Journal of Vascular Surgery
pages
1 - 15
publisher
Mosby-Elsevier
external identifiers
  • pmid:42285180
  • scopus:105042366305
ISSN
1097-6809
DOI
10.1016/j.jvs.2026.04.033
language
English
LU publication?
yes
id
f69bb6cb-c622-48bd-ba1a-3e4f18a09318
date added to LUP
2026-06-13 22:24:04
date last changed
2026-07-10 04:01:54
@article{f69bb6cb-c622-48bd-ba1a-3e4f18a09318,
  abstract     = {{Background<br/>The impact of a narrow true lumen (NTL) on the outcomes of fenestrated-branched endovascular repair in patients with postdissection thoracoabdominal aortic aneurysms (PD-TAAAs) is underreported.<br/>Methods<br/>Data from an international, multicenter registry were analyzed, to identify patients treated for PD-TAAAs (2015-2025) at 23 centers. All patients underwent fenestrated-branched endovascular repair using custom or off-the-shelf endografts. NTL was defined by a true lumen diameter &lt;25 mm identified at any aortic level on preoperative computed tomography angiogram. Short-term endpoints compared between NTL and no-NTL patients included technical success, procedural metrics, 30-day mortality, and major adverse events (MAEs). Midterm endpoints included 5-year freedom from aortic adverse events (related mortality, rupture, reintervention, endograft instability) and freedom from target artery instability.<br/>Results<br/>Among 544 patients (1705 target vessels), 438 (80%) had an NTL. Device design did not differ between groups (52% branches, 30% fenestrated, and 18% fenestrated-branched combination; P = .053). Patients with an NTL more frequently received bridging stent reinforcement (P &lt; .001), and renal inner branches (P = .038). Septotomy or false lumen occlusion were more often performed in NTLs (27% vs 11%; P = .006). Patients with NTLs 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). Overall 30-day mortality was 4%, and MAEs occurred in 35%. NTLs did not have a significant impact on MAEs (adjusted odds ratio, 0.84; 95% confidence interval [CI], 0.28-2.76; P = .766). Freedom from any aortic adverse event at 5 years was lower in patents with NTL (73% vs 91%; P = .027), driven primarily by secondary procedures of false lumen embolization (P = .027). Freedom from target vessel instability was 86% ± 4% in the NTL group and 92% ± 4% in the no-NTL group (P = .072). Patients with NTLs 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 &lt;10 mm (hazard ratio [HR], 2.45; 95% CI, 1.37-4.36; P = .002) was significantly associated with 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.<br/>Conclusions<br/>NTL is the most common anatomic presentation in PD-TAAAs and is associated with more complex procedures, but does not affect technical success, mortality, or MAEs. Patients with an NTL experience a higher rate or reinterventions, primarily false lumen embolization. NTL &lt;10 mm is a risk factor for target vessel instability, and reinforcement of bridging stents may be beneficial in these cases.}},
  author       = {{Piazza, Michele and Marrocco, Simona and Kölbel, Tilo and Tsilimparis, Nikolaos and Haulon, Stephan and Oderich, Gustavo S. and Schanzer, Andres and Melissano, Germano and Kahlberg, Andrea and Austermann, Martin and Usai, Marco V. and Mani, Kevin and Pratesi, Giovanni and Gargiulo, Mauro and Gallitto, Enrico and Bosiers, Michel J. and Veraldi, Gian Franco and Mezzetto, Luca and Bertoglio, Luca and Pulli, Raffaele and Mansour, Wassim and Dias, Nuno and Branzan, Daniela and Parlani, Gianbattista and Giudice, Rocco and Ferrer, Ciro and Yeung, Kak Khee and Tinelli, Giovanni and Tshomba, Yamume and Rohlffs, Fiona and Aru, Roberto G. and Modarai, Bijan and Abdelhalim, Mohamed and Nana, Petroula and Panuccio, Giuseppe and Apostolidis, Giorge and Schmid, Bruno and Medina, Sara and Simonte, Gioele and Isernia, Giacomo and Bastianon, Martina and Melloni, Andrea and Dioni, Pietro and Favia, Nicola and Kappe, Kaj and Salicilar, Erin and Mohammed, Yasir and Berczeli, Marton and Knappich, Cristoph and Karelis, Angelos and Bonvini, Stefano and Al-Haj, Bachar and Colacchio, Elda C. and Amvrazi, Alexia-Vasiliki and Rahman, Rafiur and Spertino, Andrea and Antonello, Michele and Squizzato, Francesco}},
  issn         = {{1097-6809}},
  language     = {{eng}},
  month        = {{06}},
  pages        = {{1--15}},
  publisher    = {{Mosby-Elsevier}},
  series       = {{Journal of Vascular Surgery}},
  title        = {{Postdissection thoracoabdominal aortic aneurysm presenting with narrow true lumen: Outcomes after fenestrated and branched endovascular repair from the international multicenter NArrow-true-lumen DIssection Registry (NADIR) study group}},
  url          = {{http://dx.doi.org/10.1016/j.jvs.2026.04.033}},
  doi          = {{10.1016/j.jvs.2026.04.033}},
  year         = {{2026}},
}