Fenestrated Endovascular Repair for Pararenal or Juxtarenal Abdominal Aortic Aneurysms: a Systematic Review

Mohamed, Naser; Galyfos, George; Anastasiadou, Christiana; Sachmpatzidis, Ioannis; Kikiras, Konstantinos; Papapetrou, Anastasios; Giannakakis, Sotirios; Kastrisios, Georgios; Papacharalampous, Gerasimos; Geroulakos, G.; Maltezos, Chrisostomos

doi:10.1016/j.avsg.2019.09.016

Cited by 13 publications

(11 citation statements)

References 44 publications

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“…16 Mortality rate at 30-days (1.2%) was low in comparison to reference data, which mostly report 30-day mortality rates around 2.5-3.0%. 1,6 Survival rates at a 1-and 3-year follow-up are in accordance with most of the available literature. 13,[17][18][19] At a 5-year follow-up, survival rates were higher in a reference study, namely 71.0%, than in the current analysis (59.9%).…”

Section: Discussionsupporting

confidence: 88%

“…A recent systematic review on FEVAR in complex AAA reported an estimated 5-year survival of 78%, although this reference meta-analysis did report an inconsistency in followup, as did other literature studies. 1 Deteriorating change in health and physical functioning in the present survey group as compared to the RAND SF-36 baseline data could be attributed to the FEVAR procedure. However, the majority of participants stressed that their decline in physical health was due to other comorbidities (such as COPD).…”

Section: Discussionmentioning

confidence: 60%

“…Care dependancy was rated through the following answer possibilities: (1) No cleaning nor nursing support; Help with cleaning; (3) Informal caregiver: help with activities of daily living (ADL); (4) Nurse: medical help and (5) Nurse: ADL support and medical help.…”

Section: Appendix Amentioning

confidence: 99%

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Long-Term Survival and Quality of Life After Fenestrated Endovascular Repair for Complex Abdominal Aortic Aneurysms

Schreuder

Dijkstra

Meijenfeldt

et al. 2023

Vasc Endovascular Surg

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Objectives Fenestrated endovascular repair (FEVAR) has become a widely used treatment option for complex abdominal aortic aneurysms (AAA) but long-term survival and quality of life (QoL) outcomes are scarce. This single center cohort study aims to evaluate both long-term survival and QoL after FEVAR. Methods All juxtarenal and suprarenal AAA patients treated with FEVAR in a single-center between 2002 and 2016 were included. QoL scores, measured by the RAND 36-Item Short Form Survey (SF-36), were compared with baseline data of the SF-36 provided by RAND. Results A total of 172 patients were included at a median follow-up of 5.9 years (IQR 3.0-8.8). Follow-up at 5 and 10 years post-FEVAR yielded survival rates of 59.9% and 18%, respectively. Younger patient age at surgery had a positive influence on 10-year survival and most patients died due to cardiovascular pathology. Emotional well-being was better in the research group as compared to baseline RAND SF-36 1.0 data (79.2 ± 12.4 vs 70.4 ± 22.0; P < 0.001). Physical functioning (50 (IQR 30–85) vs 70.6 ± 27.4; P = 0.007) and health change (51.6 ± 17.0 vs 59.1 ± 23.1; P = 0.020) were worse in the research group as compared to reference values. Conclusions Long-term survival was 60% at 5-years follow-up, which is lower than reported in recent literature. An adjusted positive influence of younger age at surgery was found on long-term survival. This could have consequences for future treatment indication in complex AAA surgery but further large-scale validation is necessary.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 60%

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Long-Term Survival and Quality of Life After Fenestrated Endovascular Repair for Complex Abdominal Aortic Aneurysms

Schreuder

Dijkstra

Meijenfeldt

et al. 2023

Vasc Endovascular Surg

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“…The patients that initially underwent FEVAR and have the longest follow up were mostly unfit for open repair. Their expected survival may therefore be limited, 15,16 which allows the repair to outlive them, or they may refuse or become too frail to allow a major re-intervention such as F/ BEVAR in FEVAR. This last concept is reinforced by similar findings seen for patients undergoing infrarenal EVAR.…”

Section: Discussionmentioning

confidence: 99%

Editor's Choice – Multicentre Outcomes of Redo Fenestrated/Branched Endovascular Aneurysm Repair to Rescue Failed Fenestrated Endografts

Karelis

Haulon

Sonesson

et al. 2021

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDSThis study describes the promising feasibility and outcomes of proximal extension with new fenestrated/ branched endovascular aneurysm repair (FEVAR/BEVAR) inside a previous failing FEVAR in many experienced aortic centres. Some of the technical challenges determined the technical success and further re-interventions were needed, but clinical success was high with no aneurysm related mortality. This establishes a baseline for comparison with other therapeutic options.Objective: To report the outcomes of redo fenestrated and/or branched endovascular aortic repair (F/BEVAR in FEVAR) to rescue previous failed FEVAR. Methods: Retrospective review of all consecutive patients undergoing F/BEVAR in FEVAR at eight aortic centres including pre-, intra-, and post-operative data according to a pre-established protocol. Follow up consisted of at least yearly computed tomography angiography. Values are presented as median and interquartile range, and survival as estimate AE standard error in percentage. Results: 18 male patients (76 years old; range 69 e 78 years) receiving FEVAR involving two (two or three) target vessels between 2006 and 2016 underwent F/BEVAR in FEVAR between 2012 and 2019 (aneurysm diameter of 63 mm; range 56 e 69 mm). Median interval between the procedures was 53 (29 e 103) months. The indication for F/BEVAR in FEVAR was type Ia endoleak in 16 cases (eight isolated and eight combined with graft migration), one graft migration without endoleak and one migration with significant proximal aortic expansion. F/BEVAR in FEVAR involved all patent renovisceral arteries and had an operating time of 260 (204 e 344) minutes. Technical success was achieved in 15 (83%) cases. There was a failure to bridge one renal artery, one renal capsular bleed with the subsequent need for renal artery embolisation within 24 hours and one persistent type Ib endoleak despite iliac extension. There was no peri-or in hospital death. Two patients developed spinal cord ischaemia, one transient paraparesis and one permanent paraplegia. The latter occurred in a non-staged procedure where spinal drainage was used. During a follow up of 27 (7 e 39) months, three (17%) patients underwent late re-interventions. Overall survival at 24 months was 70 AE 11% with no aneurysm related death and a secondary clinical success at 24 months of 84 AE 11%. Conclusion: F/BEVAR in FEVAR is a technically challenging but feasible solution to rescue failed FEVAR. The outcomes are promising in many aortic centres but need to be confirmed by further studies with longer follow up.

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“…Among them, FEVAR should be considered as a first option 1, due to their reported safety and efficacy in the VQI among others [248][249][250]. In a systematic review of 30 studies including 23,385 pats of whom 2,271 pts were treated with FEVAR for pararenal/juxtarenal AAA, the pooled early mortality reached 2.55% (ranging from 0% to 6.74%), with a pooled technical success of 96.8% (ranging from 82.8% to 100%) [251]. In a multivariate analysis, early mortality was associated with procedure time (HR, 1.007 per minute; P < .001), TAAA preoperative diameter (HR, 1.053 per millimeter; P = .001), and chronic kidney disease (HR, 3.139; P = .007) [252].…”

Section: Large Trials Meta-analyses Databases and Registries On Outcomesmentioning

confidence: 99%

Aneurysms and dissections - What is new in the literature of 2019/2020 - a European Society of Vascular Medicine annual review

Nikol

Mathias²,

Olinic

et al. 2020

Vasa

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Fenestrated Endovascular Repair for Pararenal or Juxtarenal Abdominal Aortic Aneurysms: a Systematic Review

Cited by 13 publications

References 44 publications

Long-Term Survival and Quality of Life After Fenestrated Endovascular Repair for Complex Abdominal Aortic Aneurysms

Long-Term Survival and Quality of Life After Fenestrated Endovascular Repair for Complex Abdominal Aortic Aneurysms

Editor's Choice – Multicentre Outcomes of Redo Fenestrated/Branched Endovascular Aneurysm Repair to Rescue Failed Fenestrated Endografts

Aneurysms and dissections - What is new in the literature of 2019/2020 - a European Society of Vascular Medicine annual review

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