Midterm Outcomes of a Prospective, Nonrandomized Study to Evaluate Endovascular Repair of Complex Aortic Aneurysms Using Fenestrated-Branched Endografts

• Published in: Annals of surgery Vol. 274; no. 3; pp. 491 - 499
• Main Authors: Oderich, Gustavo S., Tenorio, Emanuel R., Mendes, Bernardo C., Lima, Guilherme Baumgardt Barbosa, Marcondes, Giulianna Barreira, Saqib, Naveed, Hofer, Jan, Wong, Joshua, Macedo, Thanila A.
• Format: Journal Article
• Language: English
• Published: Lippincott Williams & Wilkins 01-09-2021
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/SLA.0000000000004982

OBJECTIVEThe aim of this study was to investigate the midterm outcomes of fenestrated and branched endovascular aortic repair (FB-EVAR) of pararenal (PRA) and thoracoabdominal aortic aneurysms (TAAAs). SUMMARY BACKGROUND DATAFB-EVAR has been associated with decreased morbidity compared to open repair, but there is limited midterm data. METHODSA total of 430 patients (302 males, mean age 74 ± 8 years) treated by FB-EVAR were enrolled in a prospective, nonrandomized investigational device exemption study. Endpoints included 30-day mortality and major adverse events (MAEs), freedom from all cause and aortic-related mortality, target vessel patency, and freedom from secondary intervention and target vessel instability. RESULTSThere were 133 PRAs and 297 TAAAs with 1673 renal-mesenteric arteries incorporated by fenestrations or directional branches (3.9 ± 0.5 vessels/patient). At 30 days or within the hospital stay if longer than 30 days, there were 4 (0.9%) deaths. MAEs included new-onset dialysis in 8 patients (2%), permanent paraplegia or stroke in 10 patients each (2%), and respiratory failure requiring tracheostomy in 2 patients (0.5%). After a mean follow-up of 26 ± 20 months, there were 3 (0.7%) aortic-related deaths from SMA stent occlusion, gastrointestinal hemorrhage, or complications of open arch repair. At 5 years, freedom from all-cause and aortic-related mortality were 57% ± 5% and 98% ± 1%, respectively. Freedom from secondary intervention was 64% ± 4%, primary target vessel patency was 94% ± 1%, and freedom from target vessel instability was 89% ± 2% at same interval. One patient (0.2%) had nonfatal aneurysm treated using endovascular repair. CONCLUSIONFB-EVAR is safe and effective for treatment of PRA and TAAAs with low rate of aortic-related mortality and aneurysm rupture on midterm follow-up.