Comparative Perioperative Outcomes of Rescue FEVAR vs Open Repair for Failed EVAR

Redo aortic repair following previous endovascular aortic repair (EVAR) is often technically challenging and associated with significant morbidity. Technologic advances in custom modified grafts have permitted increased utilization of endovascular versus open repairs. Despite this progress, there is limited data surrounding the comparative perioperative outcomes between these procedural approaches.

The National Vascular Quality Initiative (VQI) database was queried for patients undergoing elective open abdominal aortic aneurysm (AAA) repair or fenestrated endovascular aortic repair (FEVAR) with a physician-modified (PMEG) or custom graft (CMD) following a previous EVAR from 2010 to 2024. A univariate analysis to compare groups was completed with chi square and Fisher's Exact T-test, and outcomes were compared using multivariate logistic and linear regression. Data was analyzed using STATA.

900 patients underwent open repair, and 651 patents underwent FEVAR following previous EVAR. Using multivariate linear regression, patients undergoing open repair had an increased risk of postoperative pneumonia (OR 6.23, p=0.001), postoperative reintubation (OR 2.01, p=0.005), and major adverse cardiac events (OR 2.16, p=0.001) compared to patients undergoing FEVAR. Patients undergoing open repair had a higher risk of mortality (OR 2.02, p=0.018) and were less likely to be discharged home (OR 0.47, p<0.001).

Complex endovascular rescue of previously failed EVAR is associated with decreased the rate of perioperative complications compared to an open approach. FEVAR utilizing PMEG or CMD may be considered as a viable option in patients who are undergoing elective redo AAA repair following a failed EVAR.