b'Scientific Session Abstracts SUNDAY APRIL 21, 2024 37: EARLY EXPERIENCE OF PHYSICIAN MODIFIED ENDOGRAFTS FOR THE TOTAL AORTIC ARCH AND LESSONS LEARNEDRohini Patel, MD, Agustin Sibona, MD, Eugene Golts, MD, Ian Glenn, MD, Mahmoud Malas, MD, Elsie Ross, MD, Ann Gaffey, MD, Andrew Barleben, MDUniversity of California, San DiegoObjective: The purpose of this study is to describe the early results of physician modified endografts (PMEG) for varying aortic arch pathologies. These results will be submitted to the FDA for an arch specific PS-IDE. We evaluated the use of three different graft manufacturer types and multiple vessel perfusion strategies including internal branches, external branches, unstented fenestrations, stented fenestrations and stented in-situ fenestrations.Methods: We retrospectively reviewed nine patients with the intent to treat aortic arch pathologies landing proximally in Zone 0 and distally in Zone 4 or more caudal. Procedures occurred at a single institution between 12/2020 and 1/2024. Patient demographics, peri- operative and mid-term results were collected from a prospective database and analyzed. All patients were evaluated preoperatively by our multidisciplinary aortic group including CT surgery, cardiology and vascular surgery and deemed prohibitively high risk for open surgery.Results: A total of nine patients underwent PMEG arch stenting with proximal landing in Zone 0 and distal landing in Zone 4 (66%), Zone 5 (22%), Zone 10 and 11 (11% each). Average patient age was 73 (5790) and the majority were male (77%). The majority were symptomatic or ruptured (66%). Pathologies treated included aneurysm with dissection (44%), de novo arch aneurysms (44%) and a bleeding pseudoaneurysm (11%). The average maximum aneurysm diameter was 76 mm (61105 mm). Technical success, defined as delivery of all planned stents, branch vessel patency, and angiographic absence of type 1 or 3 EL, occurred in eight of nine patients (88%). One patient had inability to deliver main device across the valve and the case was aborted. All patients had a normal neurologic exam immediately post-operatively, however, 30-day mortality was not insignificant due to one patient having subsequent stroke and death (technical failure patient), a second patient after access site complication, bowel resection and sepsis and a third patient from hospital acquired pneumonia and sepsis. Reinterventions occurred in 2 patients (22%) with one delayed Type 1A endoleak and a delayed access site complication during follow-up (Avg. 6 mo, 137 months). Example cases are shown in Figures 1 and 2.Conclusions: Treatment of the aortic arch with PMEGs with versatile reconstruction strategies in patients with prohibitive risk for open surgery can have an acceptable rate of technical success and low stroke rates. This series includes highly comorbid patients with most having symptomatic or ruptured presentations and no open surgical options per a multidisciplinary team. Patient selection continues to be difficult to achieve low rates of morbidity despite relative technical success.94SOUTHERN CALIFORNIA VASCULAR SURGICAL SOCIETY'