Midterm Performance of Bridging Stent-grafts Used for Visceral Branches in Fenestrated Endovascular Aneurysm Repair

Fenestrated endovascular aneurysm repair (FEVAR) for complex aneurysms is a well-established treatment requiring the use of bridging covered stents to maintain perfusion to the visceral organs. Long-term patency is threatened by varied complications including stenosis, occlusion, and/or endoleak. These complications are collectively termed "target artery instability" (TAI). Here, we report rates of TAI and the midterm outcomes of bridging stents used in FEVAR procedures in a single center.

It is a retrospective study. Consecutive patients undergoing FEVAR between 2012 and 2020 were analyzed retrospectively. TAI for all balloon-expandable covered stents mated with reinforced fenestrations was assessed.

Ninety-six patients (95% men, median age 75) were treated with FEVAR. Eighty-nine aneurysms were juxtarenal, 7 for more proximal thoracoabdominal aneurysms. A total of 268 bridging stents were used (14 celiac, 78 in superior mesenteric artery [SMA], 176 renal). The median follow-up was 51 months (interquartile range 36-81). TAI occurred in 4.9% (n = 13) stented vessels, with 7 occlusions, 5 endoleaks, and 1 artery perforation. Eight patients required reintervention, with 2 deaths (1 from dissection of a celiac vessel and 1 SMA stent occlusion); 2 patients required long-term dialysis from the loss of perfusion to a single kidney. Overall freedom from TAI was 97% at 3 years and 95% at 5 years.

The rate of TAI was low into the medium term, using a variety of different bridging stents. TAI continued to occur after 3 years, emphasising the importance of long-term surveillance for patients undergoing FEVAR. Larger cohort studies with long-term follow-up are required.