Fenestrated Endovascular Aortic Repair and Open Surgical Repair in Patients with Type Ia Endoleak after Endovascular...

This study aimed to report the midterm results of fenestrated endovascular aortic repair (FEVAR) and open surgical repair (OSR) following failed endovascular aneurysm repair with type Ia endoleak.

An observational multicentre study was conducted in 13 French university centres, with 88 FEVARs and 120 OSRs in 208 patients. After propensity score matching, 136 matched patients were analysed.

The thirty day mortality rate was higher in the OSR group than the FEVAR group (7% vs. 3%; p = .24). Thirty day complications were statistically significantly higher in the OSR group for kidney injury (p = .001) and respiratory failure (p = .029). The rate of paraplegia was statistically significantly higher after FEVAR (6% vs. 0%, p = .042). Type Ia endoleak treatment was achieved in 67 of 68 FEVAR patients and in all OSR patients. Survival at two years was comparable between groups, being 88 ± 4% for OSR and 94 ± 3% for FEVAR (p = .83). Re-intervention free survival at two years was higher in the OSR group vs. the FEVAR group (86 ± 4% vs. 73 ± 6%; log rank, p = .037). Irrespective of the technique used, freedom from late re-intervention at two years was statistically significantly higher in patients without persistent type II endoleak (T2EL) (84 ± 6%) compared with those with persistent T2EL (43 ± 9%) (log rank, p < .001). Re-interventions occurred in 36 patients (26.5%), 30 of 68 (44%) in the FEVAR group and six of 68 (9%) in the OSR group (p < .001). Following FEVAR, aneurysm sac thrombosis was achieved in 16 of 68 patients (24%). Cox proportional hazards showed that OSR was associated with a lower probability of late re-interventions compared with FEVAR (hazard ratio [HR] 0.27, 95% confidence interval [CI] 0.11 - 0.69; p = .006) and that persistent T2EL had a greater probability of re-intervention (HR 3.09, 95% CI 1.49 - 6.41; p = .002).

In this multicentre study with propensity matching, death and complications at 30 days were higher in the OSR group, and FEVAR was associated with more late re-interventions, particularly in patients with concomitant persistent T2EL.