Spinal Cord Ischemia Prevention Through Hypogastric and Inferior Mesenteric Artery Preservation During Complex Endovascular Aortic Procedures

Abstract

1 year. Secondary outcomes were determined by Kaplan-Meier analyses.Results: This study included 107 FEVAR patients that were predominantly treated for juxtarenal aneurysm repair (90.7%) and 40 BEVAR patients that were mostly treated for repair of thoracoabdominal aneurysms (90.0%). From these, 90 FEVAR and 26 BEVAR patients were included for imaging analysis ($2 postoperative computed tomography angiographies [CTAs]). Following FEVAR, aneurysm sac volumes decreased significantly up to 24 months and remained constant thereafter, whereas aneurysm sac volumes after BEVAR did not change significantly over time (Fig 1). At last imaging follow-up, 68.9% of FEVAR treated aneurysms showed >5% shrinkage vs 29.8% after BEVAR (P < .001). FEVAR patients had higher freedom from aneurysm-related complications (3-year: FEVAR: 0.65.7%; 95% CI, 55.7%-77.6% vs BEVAR: 51.4%; 95% CI, 32.5%-81.4%; log-rank P ¼ .035) and showed higher freedom from secondary interventions (FEVAR: 84.6%; 95% CI, 77.1%-93.0% vs BEVAR: 74.8%; 95% CI, 60.9%-91.9%; log-rank P ¼ .034). However, among groups, there was no difference in freedom from endoleaks type I/III (3-year: FEVAR, 89.9%; 95% CI, 83.7%-96.6% vs BEVAR, 80.0%; 95% CI, 64.5%-99.4%; log-rank P ¼ .13). Finally, early aneurysm sac shrinkage showed significant higher freedom from the composite outcome (log-rank P ¼ .022) (Fig 2).Conclusions: Initial sac regression at 1 year is significantly associated with improved clinical outcomes; freedom from aneurysm-related complications. Both BEVAR and FEVAR need secondary interventions in the first year to maintain clinical success. The proportion of patients with sac regression after BEVAR is lower compared with FEVAR, and therefore will probably require more intensified surveillance.