{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T09:18:10Z","timestamp":1787735890625,"version":"build-2784847793"},"reference-count":33,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: To present perioperative and follow-up outcomes of physician-modified endograft (PMEG) repair for juxtarenal and pararenal abdominal aortic aneurysms. Methods: This PRISMA 2020 systematic review and single-arm meta-analysis was registered with PROSPERO (CRD420261340339). PubMed, Embase, Web of Science, the Cochrane Library, and ClinicalTrials.gov were searched until December 2025. Eligible reports described full-text-confirmed cohorts of at least five patients treated with PMEG. The strict primary analysis required endpoint-separable juxtarenal or pararenal populations and used random-effects generalized linear mixed models for pooled proportions. Methodological quality and evidence certainty were assessed using the Joanna Briggs Institute checklist and GRADE framework. Results: Fifteen eligible reports described 981 patients before overlap adjudication; 10 reports originated from one institution and contained overlapping populations. After pathology and endpoint-level overlap adjudication, one to four independent populations informed each endpoint estimate, and single-source outcomes were not pooled. Technical success was 97.8% (95% CI, 94.8\u201399.1%; three populations, 228 patients), and 30-day mortality was 2.3% (95% CI, 1.1\u20134.8%; four populations, 299 patients). Acute kidney injury, stroke, and spinal cord ischemia occurred in 4.5%, 1.6%, and 1.7% of patients, respectively. During available follow-up, the single-source Type III endoleak estimate was 3.4% (7\/203), any reintervention was 13.2% (95% CI, 2.9\u201343.7%; two populations, 217 patients; I2 = 89.0%), and patient-level target-vessel occlusion was 2.4% (95% CI, 0.6\u20139.1%; 2 populations, 83 patients). Follow-up estimates were exploratory report-period proportions. GRADE certainty was very low for all key outcomes. Conclusions: PMEG repair demonstrated a high technical-feasibility signal and low observed early event rates in experienced centers, but clinical effectiveness and durability remain uncertain. The evidence base is dominated by overlapping expert-center reports and should not be interpreted as establishing equivalence or superiority to custom-manufactured FEVAR.<\/jats:p>","DOI":"10.3390\/jcm15176578","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T08:11:15Z","timestamp":1787731875000},"page":"6578","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Outcomes of Physician-Modified Endografts for Juxtarenal and Pararenal Abdominal Aortic Aneurysms: A Systematic Review and Single-Arm Meta-Analysis"],"prefix":"10.3390","volume":"15","author":[{"given":"Haoran","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Vascular Surgery, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4518-9810","authenticated-orcid":false,"given":"Mohammed","family":"Al-Falahi","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7497-1858","authenticated-orcid":false,"given":"Bernhard","family":"Hruschka","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4876-4873","authenticated-orcid":false,"given":"Panagiotis","family":"Doukas","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Uhl","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8416-4624","authenticated-orcid":false,"given":"Jelle","family":"Frankort","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8451-2913","authenticated-orcid":false,"given":"Alexander","family":"Gombert","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1016\/j.jvs.2010.01.049","article-title":"Juxtarenal aortic aneurysm repair","volume":"52","author":"Jongkind","year":"2010","journal-title":"J. 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