European Multicentric Experience With Fenestrated-branched ENDOvascular Stent Grafting After Previous FAILed Infrarenal Aortic Repair

Abstract

Objective: To report the mid-term outcomes of fenestrated-branched endovascular aneurysm repair (F-BEVAR) following a failed previous endovascular aneurysm repair (pEVAR) or previous open aneurysm repair (pOAR). Methods: Data from consecutive patients who underwent F-BEVAR for pEVAR or pOAR from 2006 to 2021 from 17 European vascular centers were analyzed. Endpoints included technical success, major adverse events, 30-day mortality, and 5-year estimates of survival, target vessel primary patency, freedom from reinterventions, type I/III endoleaks, and sac growth >5 mm. Background: Treatment of a failed previous abdominal aortic aneurysm repair is a complex undertaking. F-BEVAR is becoming an increasingly attractive option, although comparative data are limited regarding associated risk factors, indications for treatment, and various outcomes. Results: There were 526 patients included, 268 pOAR and 258 pEVAR. The median time from previous repair to F-BEVAR was 7 (interquartile range, 4–12) years, 5 (3–8) for pEVAR, and 10 (6–14) for pOAR, P<0.001. Predominant indication for treatment was type Ia endoleak for pEVAR and progression of the disease for pOAR. Technical success was 92.8%, pOAR (92.2%), and pEVAR (93.4%), P=0.58. The 30-day mortality was 6.5% overall, 6.7% for pOAR, and 6.2% for pEVAR, P=0.81. There were 1853 treated target vessels with 5-year estimates of primary patency of 94.4%, pEVAR (95.2%), and pOAR (94.4%), P=0.03. Five-year estimates for freedom from type I/III endoleaks were similar between groups; freedom from reintervention was lower for pEVAR (38.3%) than for pOAR (56.0%), P=0.004. The most common indication for reinterventions was for type I/III endoleaks (37.5%). Conclusions: Repair of a failed pEVAR or pOARis safe and feasible with comparable technical success and survival rates. While successful treatment can be achieved, significant rates of reintervention should be anticipated, particularly for issues related to instability of target vessels/bridging stents.

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 ].…”

Secondary Endovascular Conversions for Failed Open Repair

“…6,7 Several studies have been published demonstrating the use of endovascular repair in these situations. 7,8 Spanos et al 7 have published a systematic review and meta-analysis analyzing the outcomes of endovascular treatment of paraanastomotic aneurysms after abdominal aortic surgery. Overall, 18 studies were included, totaling 433 patients.…”