Outcomes of fenestrated endovascular repair of juxtarenal aortic aneurysm

Abstract

Objective: To evaluate late outcomes after fenestrated endovascular aortic repair (f-EVAR) in a tertiary European referral center.

Methods: In 2009, we published short- and midterm results after f-EVAR in the first 54 patients treated with this technique at our center between September 2002 and June 2007. In this paper, we provide long-term follow-up of the same patient cohort with the main focus on target vessel (TV) patency, renal function, reinterventions, and survival.

Results: A total of 54 patients were included in this study. Median age was 72 years (interquartile range [IQR], 68-76 years) at primary operation, and 85% were men. Median preoperative aneurysm diameter was 60 mm (IQR, 53-66 mm). One hundred thirty-four vessels were targeted (mean, 2.5 per patient), and 96 TV stents were placed. The median clinical follow-up was 67 months (IQR, 37-90 months), and computed tomography follow-up was 60 months (IQR, 35-72 months). Aneurysm diameter decreased ≥ 5 mm in 39% ± 7% at 12 months, 64% ± 8% at 36 months, and 71% ± 8% at 60 months. Primary TV patency was 94% ± 2% at 12 months, 91% ± 3% at 36 months, and 90% ± 3% at 60 months. Glomerular filtration rate decreased by 17% at 59 months (IQR, 26-73 months) follow-up (60 [IQR, 46-79] vs 50 [IQR, 38-72] mL/min/1.73 m(2); P < .001), and one patient became dialysis-dependent secondary to a renal stent occlusion. Reintervention-free survival was 88% ± 5% at 12 months, 69% ± 7% at 36 months, and 56% ± 5% at 60 months. At least one reintervention was done in 37% of patients, of which 29% were endoleak-related, 26% TV-related, 13% graft-limb-related, and 32% due to other causes. The majority of reinterventions (68%) were based on complications detected on routine follow-up. Estimated overall survival was 93% ± 4% at 12 months, 76% ± 6% at 36 months, and 60% ± 7% at 60 months. In total, 54% of the patients died during the 10-year study period, where 9% died of aneurysm-related causes.

Conclusions: Long-term mortality after f-EVAR is high, but most patients die from nonaneurysmal causes. Aneurysm-related mortality is associated with technical complications that can be reduced with increased experience. Reinterventions are common, and most complications are detected on routine follow-up.