Graft Complexity–Related Outcomes of Fenestrated Endografting for Abdominal Aortic Aneurysms

Abstract

PURPOSE: To report the outcomes of fenestrated endovascular aneurysm repair (FEVAR) and compare early and midterm results in relation to stent-graft complexity. METHODS: Between August 2006 and December 2014, 141 consecutive patients (mean age 72±7.6 years, range 50-89; 120 men) were treated electively with FEVAR for short-neck, juxtarenal, or suprarenal aortic aneurysms. Forty-five patients treated with stent-grafts featuring renal-only fenestrations were assigned to group A, while 96 patients receiving additional fenestrations for the superior mesenteric and/or celiac arteries were assigned to group B. Technical success, operative mortality and morbidity, target vessel patency, endoleak, reintervention, and survival were compared between the groups. Survival, target vessel stent patency, and reintervention during follow-up were estimated by Kaplan-Meier analysis; the estimates are presented with the 95% confidence interval (CI). RESULTS: Technical success was achieved in 135 (95.7%) patients. Overall 30-day operative mortality was 3.5% (5/141). Perioperative complications occurred in 16 (12.1%) patients. Mean follow-up was 33±23 months. Overall estimated survival was 85.1% (95% CI 79.1% to 91.1%) at 1 year and 75.8% (95% CI 68.2% to 83.5%) at 3 years. Freedom from reintervention was 90.6% (95% CI 85.6% to 95.6%) at 1 year and 79.2% (95% CI 71% to 87.5%) at 3 years. There was no statistically significant difference between the groups in terms of perioperative mortality or morbidity, endoleak, survival, target vessel patency, or reintervention. CONCLUSION: The use of FEVAR for juxta-and suprarenal aneurysms is associated with low 30-day mortality/morbidity and high midterm efficacy. So far, perioperative and midterm results are not affected by the use of more complex fenestrated designs.

Outcome of Surgeon-Modified Fenestrated/Branched Stent-Grafts for Symptomatic Complex Aortic Pathologies or Contained Rupture

“…Fenestrated and branched stent-grafts for complex abdominal and thoracoabdominal aortic repair in high-risk patients and elective cases have become a safe approach, with low perioperative morbidity and mortality. 8,[22][23][24] Since customized endografts take weeks for delivery and off-theshelf devices for complex aortic anatomy are limited, the surgeon-modified stent-graft appears to be an effective endovascular option because it facilitates an anatomically correct reconstruction; modification of the endograft takes only about 1 to 2 hours. Limitation of this technique is that it can be applied only to hemodynamically stable patients due to the modification time.…”

Short- and Midterm Outcomes of Open Repair and Fenestrated Endografting of Pararenal Aortic Aneurysms in a Concurrent Propensity-Adjusted Comparison

“…To incorporate the visceral vessels into the repair and extend the proximal sealing zone, fenestrated endovascular aortic repair (fEVAR) emerged and has gained acceptance in centers of excellence. [3][4][5] The aim of the present study was to compare short-and midterm outcomes of patients treated with fEVAR and OSR for pararenal aortic aneurysms in patients from a group of highvolume centers in which both techniques were sufficiently well established to allow an up-to-date comparison of results.…”

“…To incorporate the visceral vessels into the repair and extend the proximal sealing zone, fenestrated endovascular aortic repair (fEVAR) emerged and has gained acceptance in centers of excellence. 3–5…”

Changes in Target Vessel Anatomy Following Fenestrated Endovascular Aneurysm Repair: Midterm Results

“…One of the key improvements was the introduction of BSGs leading to higher TV patency rates, 9 which are currently reported as 92% to 99% in mid-to long-term follow-up. [10][11][12][13] However, most of the reinterventions following fEVAR are still for TV-associated complications 4,5 and may be related to anatomical changes induced by the operation. 6,7 Indeed, significant anatomical changes of the renovisceral arteries can be observed immediately after fEVAR.…”