Indications, planning, and technical aspects in physician-modified endografts based on a cross-sectional global survey.

Abstract

To assess real-world variability in physician-modified endograft (PMEG) use through a global survey, providing insights to guide standardization and improve patient outcomes. A global cross-sectional survey was conducted using a 31-question web-based questionnaire distributed to 4286 vascular specialists via email, professional networks, and online platforms. The survey addressed practitioner demographics, experience, PMEG indications, device selection, planning, and technical aspects. Responses were collected over 6 months and analyzed with descriptive statistics and subgroup comparisons. The survey received 227 responses from 30 countries; 85% were vascular surgeons and 21.6% had performed more than 30 PMEG cases. Medicolegal concerns were common, with only 16.1% reporting none. Device selection varied, with 52% preferring thoracic grafts and 30% bifurcated endografts. Planning strategies differed: 26% considered 15 mm a sufficient sealing zone, 33% required at least 20 mm, and 29.1% opted for 25 mm or more. Although 67% did not use three-dimensionally printed templates for fenestration positioning, 21.6% routinely did, mostly with in-house printing. Geographic analysis showed US respondents were less likely to use PMEG for postdissection aneurysms and severe target vessel stenosis, whereas experience-based analysis identified several significant differences in back-table modification techniques. This survey highlights variability in PMEG practice, with several technical aspects significantly associated with practitioner experience. The findings underscore the need to standardize indications, planning, and execution to enhance procedural safety and consistency, providing a foundation for future research, expert consensus, and structured training programs.