Thirty-day outcomes after fenestrated endovascular repair are superior to open repair of abdominal aortic aneurysms involving visceral vessels

Gupta, Prateek K.; Brahmbhatt, Reshma; Kempe, Kelly; Stickley, Shaun M.; Rohrer, Michael J.

doi:10.1016/j.jvs.2017.04.057

Cited by 27 publications

(13 citation statements)

References 25 publications

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“…11 Additionally, recent studies comparing endovascular versus open repair of CAAs using NSQIP data set have also demonstrated higher mortality following OAR compared to endovascular repair. 12,13 However, these results are not consistent with systematic reviews in the literature. Three different systematic reviews on juxtarenal AAA found no difference in mortality between endovascular and OAR, which may be related to the strict inclusion criteria.…”

Section: Discussioncontrasting

confidence: 80%

Thirty-Day Outcomes of Fenestrated and Chimney Endovascular Repair and Open Repair of Juxtarenal, Pararenal, and Suprarenal Abdominal Aortic Aneurysms Using National Surgical Quality Initiative Program Database (2012-2016)

Locham

Dakour-Aridi

Bhela

et al. 2018

Vasc Endovascular Surg

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Background: Fenestrated endovascular repair (FEVAR) and chimney endovascular repair (ChEVAR) endovascular repair offer a less invasive alternative to open aortic repair (OAR) in managing juxtarenal, pararenal, and suprarenal abdominal aortic aneurysms (AAAs). The aim of this study is to evaluate the 30-day postoperative outcomes following endovascular and open repair of nonruptured AAA involving the renal vessels. Study Design: All patients undergoing endovascular (FEVAR and ChEVAR) and open repair of juxtarenal, pararenal, and suprarenal AAA in National Surgical Quality Improvement Program database from 2012 to 2016 were included. Continuous and categorical covariates were analyzed using medians and w 2 /Fisher exact test, respectively. Multivariable logistic regression analyses were performed to evaluate primary (mortality) and secondary (renal and cardiopulmonary failure) outcomes between open versus endovascular approach. Results: A total of 1191 patients underwent AAA repair using open (72%) or endovascular (FEVAR: 14%, ChEVAR: 14%) approach. In univariate analysis, no significant difference in 30-day mortality was seen between the 3 groups (FEVAR: 2.47% vs ChEVAR: 7.32% vs OAR: 6.13%, P ¼ .13). However, 30-day major complications including renal failure (9.36% vs 6.10% vs 1.85%, P ¼ .003) and cardiopulmonary complications (19.77% vs 3.66% vs 4.94%, P < 001) failure were significantly higher in patients undergoing OAR versus ChEVAR versus FEVAR. After adjusting for potential confounders, OAR was associated with 2-to 5-folds increased risk of mortality (odds ratio, OR [95% confidence interval, CI]: 2.14 [1.09-4.21], P ¼ .03), renal (OR [95% CI]: 2.87 [1.48-5.57], P ¼ .002), and cardiopulmonary failure (OR [95% CI]: 4.63 [2.47-8.67], P < .001) compared to any endovascular repair. Conclusion: Using a large national surgical data set, our study found 2-to 5-folds higher mortality and morbidity in patients undergoing open versus endovascular repair of AAA involving the renal vessels. Endovascular repair seems to be a safer approach, especially when managing older patients with AAA.

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Section: Discussioncontrasting

confidence: 80%

Thirty-Day Outcomes of Fenestrated and Chimney Endovascular Repair and Open Repair of Juxtarenal, Pararenal, and Suprarenal Abdominal Aortic Aneurysms Using National Surgical Quality Initiative Program Database (2012-2016)

Locham

Dakour-Aridi

Bhela

et al. 2018

Vasc Endovascular Surg

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“…In the absence of prospective randomized trials, results of this study should be analyzed in the context of the historical outcomes obtained with alternative techniques. Gupta et al 13 reported a retrospective analysis of 1742 patients treated by open surgical repair or FEVAR using the American College of Surgeons National Surgical Quality Improvement Program database. In that study, open surgical repair was associated with a twofold increase in 30day mortality (4.7% vs 2.4%) and significantly higher rates of early pulmonary complications, cardiac events, new onset dialysis, stroke, return to the operating room, and transfusion requirements, as well as longer length of stay.…”

Section: Discussionmentioning

confidence: 99%

“…In that study, open surgical repair was associated with a twofold increase in 30day mortality (4.7% vs 2.4%) and significantly higher rates of early pulmonary complications, cardiac events, new onset dialysis, stroke, return to the operating room, and transfusion requirements, as well as longer length of stay. 13 O'Donnell et al 14 analyzed data from the Society a The clinical events committee adjudicated this as related to component failure and noted that they did not consider this event to be an aneurysm rupture, but rather an endoleak due to the leak of contrast into the aneurysm sac. b This was according to site assessment; the endoleak was type II according the core laboratory analysis of the follow-up imaging before the secondary intervention.…”

Section: Discussionmentioning

confidence: 99%

Final 5-year results of the United States Zenith Fenestrated prospective multicenter study for juxtarenal abdominal aortic aneurysms

Oderich

Farber

Schneider

et al. 2021

Journal of Vascular Surgery

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“…For this reason, the European Society for Vascular and Endovascular Surgery does not recommend the use of more than two chimney grafts, limiting the use of this technique in patients requiring seal above the superior mesenteric artery (SMA). (Gupta et al, 2017 )…”

Section: Introductionmentioning

confidence: 99%

Clinical application and technical details of cook zenith devices modification to treat urgent and elective complex aortic aneurysms

et al. 2021

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Purpose To describe technical details of modifying four different Cook Zenith devices to treat complex aortic aneurysms. Material In the first three cases, the modification process involved complete stent graft deployment on a sterile back table. Fenestrations were created using an ophthalmologic cautery and reinforced with a radiopaque snare using a double-armed 4–0 Ethibond locking suture based on measurements obtained on centerline of flow. In each instance, a nitinol wire was withdrawn and redirected through and through the fabric and used as a constraining wire. In the fourth patient, modification involved partial stent graft deployment and creation of additional two fenestrations to accommodate renal arteries. The devices are resheathed and implanted in the standard fashion. Results Four patients underwent exclusion of their aneurysms, including thoracoabdominal aneurysms (n = 2), a contained ruptured juxtarenal aneurysm (n = 1), and a ruptured failed previous endovascular repair (n = 1). Fifteen fenestrations were successfully bridged with Atrium iCAST stent grafts. Average graft modification time, operative time, contrast volume, radiation dose, estimated blood loss, and hospital length of stay were 89 min, 155.25 min, 58.8 mL, 2451 mGy, 175 mL, and 4.3 days, respectively. One patient required a secondary intervention to treat a type Ib endoleak. During an average follow-up of 25 months, aneurysm sacs progressively shrank without additional intervention. Conclusion Physician-modified fenestrated/branched endografts are a safe alternative to custom made devices, especially in urgent cases and should be part of the armamentarium of any complex aortic program.

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Thirty-day outcomes after fenestrated endovascular repair are superior to open repair of abdominal aortic aneurysms involving visceral vessels

Abstract: FEVAR is associated with a lower risk for 30-day mortality and adverse events compared with OS for AAA-Vs.

Cited by 27 publications

References 25 publications

Thirty-Day Outcomes of Fenestrated and Chimney Endovascular Repair and Open Repair of Juxtarenal, Pararenal, and Suprarenal Abdominal Aortic Aneurysms Using National Surgical Quality Initiative Program Database (2012-2016)

Thirty-Day Outcomes of Fenestrated and Chimney Endovascular Repair and Open Repair of Juxtarenal, Pararenal, and Suprarenal Abdominal Aortic Aneurysms Using National Surgical Quality Initiative Program Database (2012-2016)

Final 5-year results of the United States Zenith Fenestrated prospective multicenter study for juxtarenal abdominal aortic aneurysms

Clinical application and technical details of cook zenith devices modification to treat urgent and elective complex aortic aneurysms

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