Characterising the incidence and mode of visceral stent failure after fenestrated endovascular aneurysm repair (FEVAR)

Abstract

Background In FEVAR, visceral stents provide continuity and maintain perfusion between the main body of the stent and the respective visceral artery. The aim of this study was to characterise the incidence and mode of visceral stent failure (type Ic endoleak, type IIIa endoleak, stenosis/kink, fracture, crush and occlusion) after FEVAR in a large cohort of patients at a high-volume centre. Methods A retrospective review of visceral stents placed during FEVAR over 15 years (February 2003-December 2018) was performed. Kaplan-Meier analyses of freedom from visceral stent-related complications were performed. The outcomes between graft configurations of varying complexity were compared, as were the outcomes of different stent types and different visceral vessels. Results Visceral stent complications occurred in 47/236 patients (19.9%) and 54/653 stents (8.3%). Median follow up was 3.7 years (IQR 1.7–5.3 years). There was no difference in visceral stent complication rate between renal, SMA and coeliac arteries. Visceral stent complications were more frequent in more complex grafts compared to less complex grafts. Visceral stent complications were more frequent in uncovered stents compared to covered stents. Visceral stent-related endoleaks (type Ic and type IIIa) occurred exclusively around renal artery stents. The most common modes of failure with SMA stents were kinking and fracture, whereas with coeliac artery stents it was external crush. Conclusion Visceral stent complications after FEVAR are common and merit continued and close long-term surveillance. The mode of visceral stent failure varies across the vessels in which the stents are located.

Three-Dimensional Geometric Analysis of Balloon-Expandable Covered Stents Improves Classification of Complications after Fenestrated Endovascular Aneurysm Repair

“…Intravascular ultrasound (IVUS) is another potential technique to detect branch instability that is missed by angiography [ 24 ]. However, these promising developments will not resolve all postoperative bridging stent complications that occur in 20% of FEVAR-patients and in 8% of stents at median (IQR) follow-up of 3.7 years (1.7−5.3) [ 6 ]. Correct classification of the endoleak or obstruction on post-FEVAR CTA imaging remains essential to determine the exact cause of the failure and hence choose the appropriate reintervention.…”

“…Reinterventions have been reported in 20% to 39% of FEVAR patients after 2.0 to 7.5 years of follow-up [ 3 , 4 , 5 , 6 ]. Approximately half of these reinterventions are performed for BECS-associated complications [ 3 ].…”

“…Approximately half of these reinterventions are performed for BECS-associated complications [ 3 ]. These complications can be divided into endoleak, stenosis and/or occlusion, or stent fracture with occurrence rates of 12%, 6%, and 6%, respectively [ 3 , 6 ]. Most durability studies, however, are limited in including heterogeneous groups of patients and BECSs, with short-term follow-up, and/or a mixture of fenestrated and branched endovascular repair [ 7 ].…”

Geometric analysis of stent grafts to anticipate complications after endovascular aortic aneurysm repair

“…Reinterventions have been reported in 20% to 39% of FEVAR patients after 2.0 to 7.5 years of follow-up. [13,[141][142][143] Approximately half of these reinterventions are performed for BECS-associated complications. [13] These complications can be divided into endoleak, stenosis and/or occlusion, or stent fracture with occurrence rates of 12%, 6%, and 6%, respectively.…”

“…[13] These complications can be divided into endoleak, stenosis and/or occlusion, or stent fracture with occurrence rates of 12%, 6%, and 6%, respectively. [13,143] Most durability studies, however, are limited in including heterogeneous groups of patients and BECSs, with short-term follow-up, and/or a mixture of fenestrated and branched endovascular repair. [20] In case of an endoleak at follow-up, it can be difficult to detect which fenestration (and subsequent BECS) causes the problem.…”