Updates of the TIGRE Registry: anatomic hostility does not affect mid-term outcomes of endovascular aortic repair with the E-Tegra endograft

BACKGROUND: The preliminary outcomes of the e-Tegra Endograft Italian Registry (TIGRE) confirmed safety and effectiveness of this new-generation device in treating aneurysms with standard and hostile anatomy on the short-term. However, the specific behavior of E-Tegra in aneurysms with different levels of anatomic hostility has not been assessed yet. The aim of this study was to analyze the latest data from the Registry, focusing on the endograft behavior in treating abdominal aortic aneurysms (AAAs) with hostile proximal and distal anatomy. METHODS: The latest available follow-up data of the Registry were analyzed, taking as primary endpoints freedom from aortic-related mortality, any type of postoperative complications and reinterventions at two years. The secondary endpoint was AAA shrinkage, defined as reduction >10 mm during follow-up. Univariate analyses were performed to verify the relation between the outcome measures and four degrees of anatomic hostility. Multivariate analyses were also performed to assess the impact of four covariates: male sex, concomitant iliac aneurysms, presence of >2 pairs of lumbar arteries or a polar renal artery, and urgent/emergent procedure. RESULTS: One hundred forty-four out of 147 patients completed the scheduled follow-up; three patients died for aortic-unrelated causes. Overall complications were 16 (10.88%), in 13 patients: 8 type II endoleaks, 6 iliac limb occlusions and 2 type IB endoleaks. 7 patients (4.76%) underwent reinterventions: 3 type II endoleaks selectively embolized and one treated by open conversion; 2 type IB endoleak, corrected by endovascular relining, and one iliac limb occlusion, revascularized with a cross-over bypass. 106 AAA (72.11%) had a significant aneurysm shrinkage, 35 (23.80%) remained stable and 6 an increase. Univariate analysis found no significant association between any degree of anatomic hostility and the primary and secondary endpoints. Multivariate analysis found a significant association of the number of vessels arising from the aneurysms with complications, but not with reinterventions. CONCLUSIONS: The mid-term outcomes of the Registry confirm optimal safety and effectiveness of the E-Tegra endograft in treating AAAs with hostile and standard anatomy. Univariate and multivariate analyses showed no significant differences in terms of complications or reinterventions based on hostile anatomy levels.