Comparison of Early and Mid-Term Outcomes After Fenestrated-Branched Endovascular Aortic Repair in Patients With or Without Prior Infrarenal Repair

Abstract

Objective: The purpose of this study was to compare short- and mid-term outcomes of fenestrated-branched endovascular repair (F-BEVAR) of pararenal (PRAA)/thoracoabdominal (TAAA) aortic aneurysms in patients with or without prior endovascular/open (EVAR/OAR) infrarenal aortic repair. Methods: Data from consecutive F-BEVAR (2010–2019) at two high-volume aortic centers were retrospectively reviewed. Primary endpoints were technical success, 30-day mortality, and overall survival. Secondary endpoints included 30-day major adverse events (MAE), freedom from type I/III endoleaks, reinterventions, sac expansion, and target vessel (TV) primary patency. Results: A total of 222 consecutive patients were included for analysis; of these 58 (26.1%) had prior infrarenal repair (EVAR=33, OAR=25) and 164 (73.9%) had native PRAA/TAAA. At baseline, patients with prior infrarenal repair were older (mean age=75.1 vs 71.6 years, p=.005) and the proportion of females was lower (8.6% vs 29.3%, p=.002). Technical success was 97.8% (n=217) in the entire cohort, without any significant differences between study groups (94.8% vs 98.8%, p=.08). At 30 days, there were no significant differences between patients with prior infrarenal repair as compared with those without in rate of MAE (44.8% vs 54.9%, p=.59). The 5-year estimate of survival for those who underwent native aortic repair was 61.6%, versus 61.3% for those who had a previous repair (p=.67). The 5-year freedom from endoleaks I/III estimates were significantly lower in patients who had prior infrarenal repair as compared with patients undergoing treatment of native aneurysms (57.1% vs 66.1%, p=.03), mainly owing to TV-related endoleaks (ie, type IC and/or IIIC endoleaks). No significant differences were found between study groups in rates of reinterventions and TV primary patency. Five-year estimates of freedom from sac increase >5mm were significantly lower in patients who received F-BEVAR after previous infrarenal repair as compared with those who underwent treatment of native aneurysms (48.6% vs 77.5%, p=.002). Conclusions: F-BEVAR is equally safe and feasible for treatment of patients with prior infrarenal repair as compared with those undergoing treatment for native aneurysms. Increased rates of TV-related endoleaks were observed which could lead to lower freedom from aneurysm sac shrinkage during follow-up. Nevertheless, the 5-year rates of reinterventions and TV patency were similar, thereby indicating that overall effectiveness of treatment remained satisfactory at mid-term.

A Scoping Review on the Incidence, Risk Factors, and Outcomes of Proximal Neck Dilatation after Standard and Complex Endovascular Repair for Abdominal Aortic Aneurysms

“…Fenestrated-branched EVAR (F-B/EVAR) moves the proximal zone above the renal-visceral vessel where the native aorta is less prone to dilation and it may represent a feasible and safe alternative to EVAR in the case of hostile neck, especially for patients unfit for open surgical repair or for those with long life expectancy [ 38 ]. According to the outcomes of high-volume aortic centers, F-B/EVAR may be also proposed as the first-line approach in the case of proximal complication after EVAR, with satisfactory clinical outcomes comparable with patients undergoing treatment for native aneurysm [ 39 , 40 ].…”

Mid-Term Results of Fenestrated Endovascular Repair after Prior Open Aortic Reconstruction

“…An increased rate of target vessel-related endoleaks was found in patients with a prior repair in this study. However, this increase did not correlate with higher rates of reinterventions or lower primary patency at 5-year follow-up [ 5 ].…”

“…Still, the chronic nature of aneurysmal disease can contribute to the appearance of late aortic complications such as para-anastomotic aneurysms (PAA) and progression of disease with dilatation of the proximal aorta. Both clinical situations are challenging as they frequently involve the pararenal/paravisceral aorta and often occur in patients that are older and present more comorbidities than those treated for a primary AAA [ 3 , 4 , 5 ].…”

Single-branched stent-graft with on-table fenestration for endovascular repair of primary retrograde type A aortic dissection: A multicenter retrospective study

“…Previous studies have reported that fenestration and chimney techniques may be feasible for treating some aortic arch pathologies while preserving the blood supply of the brain and upper extremities in selected patients ( 22 ). However, the incidence of intraoperative endoleaks and the risk of cerebral infarction were underestimated for the chimney technique ( 23 ), especially in cases with an entry tear located very close to the beginning of branch arteries.…”