Outcome After Fenestrated and Branched Repair of Aortic Aneurysms-Device Failures Predict Reintervention Rates

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Aortic Aneurysm Repair

Background:

• Endovascular repair is generally safe and effective for complex aortic aneurysms.
• Rapid evolution of endovascular technology necessitates ongoing evaluation of fenestrated and branched endovascular aneurysm repair (F/B-EVAR) outcomes.
• This study aimed to analyze outcomes of F/B-EVAR for complex abdominal aortic aneurysms (AAA) and thoracoabdominal aortic aneurysms (TAAA).

Purpose of the Study:

• To evaluate the outcomes of fenestrated and branched endovascular aneurysm repair (F/B-EVAR) in complex aortic aneurysms.
• To identify factors contributing to reintervention and adverse events.
• To assess the long-term performance of bridging stent grafts.

Main Methods:

• Retrospective cohort study of 72 patients undergoing F/B-EVAR from August 2009 to December 2018.
• Primary outcomes included branch instability and freedom from reintervention at 2 years.
• Secondary outcomes assessed major adverse events and all-cause mortality at 30 and 90 days.

Main Results:

• A total of 219 vessels were stented in 72 patients (55 complex AAA, 17 TAAA).
• Fractured first-generation BeGrafts were the primary cause of reintervention (6/41 BeGrafts vs. 0/61 other stents).
• Two-year freedom from reintervention was 75% for complex AAA and 35% for TAAA, improving to 79% and 66% respectively when excluding BeGrafts. Spinal cord ischemia (SCI) was the most common major adverse event (8.3%).

Conclusions:

• High rates of branch instability and reintervention were linked to fractured first-generation BeGrafts.
• Mortality and major adverse event rates were low.
• Long-term surveillance of bridging stent graft performance is essential, and reporting of failing materials is critical to prevent complications.