Rescue of Failed Aortic Repair with Fenestrated Endovascular Device

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Aortic Aneurysm Repair

Background:

• Increasing incidence of failed endovascular (EVAR) and open repair (OR) necessitates redo aortic repair in 10% of patients.
• Proximal type 1a endoleaks or proximal dilatation after EVAR/OR can be treated with fenestrated endovascular aortic repair (FEVAR).
• FEVAR utilizes custom-made grafts to extend the sealing zone to healthier thoracic aorta above visceral arteries.

Purpose of the Study:

• To present a single-center experience using fenestrated endovascular aortic repair (FEVAR) as a rescue therapy for failing aortic repairs.
• To evaluate the safety and efficacy of the Zenith Fenestrated endovascular (ZFEN) device in this challenging patient cohort.
• To assess technical success, complications, and survival rates in patients undergoing redo aortic repair with FEVAR.

Main Methods:

• A prospectively maintained database of FEVAR patients treated with the Zenith Fenestrated endovascular (ZFEN) device was analyzed.
• Patients who received the ZFEN device as rescue therapy after prior EVAR or OR were included.
• Statistical analysis was performed using SPSS v 25 software.

Main Results:

• Seventeen ZFEN devices were implanted between January 2011 and March 2019 for failed EVAR (10 patients) or OR (7 patients).
• Primary technical success was 70.5%, with a 30-day re-intervention rate of 23.5%.
• Peri-operative complication rates were 5.8% for deployment-related issues and 35% for systemic complications; one-year survival was 92% with no mortality.

Conclusions:

• FEVAR is a safe yet technically demanding option for rescuing failing aortic repairs.
• Patients undergoing FEVAR are high-risk, reflected in significant post-operative morbidity.
• Despite challenges, FEVAR achieved high technical success and low 30-day mortality in this cohort.