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. 2017 Jul;104(8):1020-1027.
doi: 10.1002/bjs.10524. Epub 2017 Apr 12.

Long-term follow-up of fenestrated endovascular repair for juxtarenal aortic aneurysm

I N Roy  1   2 , A M Millen  1 , S M Jones  1 , S R Vallabhaneni  1   2 , J R H Scurr  1 , R G McWilliams  3 , J A Brennan  1 , R K Fisher  1
Affiliations

Long-term follow-up of fenestrated endovascular repair for juxtarenal aortic aneurysm

I N Roy et al. Br J Surg. 2017 Jul.

Abstract

Background: Fenestrated endovascular aneurysm repair (FEVAR) is increasingly being used for juxtarenal aortic aneurysms. The aim of this study was to review long-term results and assess the importance of changing stent-graft design on outcomes.

Methods: This was a retrospective review of all patients who underwent FEVAR within a single unit over 12 years (February 2003 to December 2015). Kaplan-Meier analysis of survival, and freedom from target vessel loss, aneurysm expansion, graft-related endoleak and secondary intervention was performed. Comparison between outcomes of less complex grafts (fewer than 3 fenestrations) and more complex grafts (3 or 4 fenestrations) was undertaken.

Results: Some 173 patients underwent FEVAR; median age was 76 (i.q.r. 70-79) years and 90·2 per cent were men. Median aneurysm diameter was 63 (59-71) mm and median follow-up was 34 (16-50) months. The adjusted primary technical operative success rate was 95·4 per cent. The in-hospital mortality rate was 5·2 per cent; there was no known aneurysm-related death during follow-up. Median survival was 7·1 (95 per cent c.i. 5·2 to 8·1) years and overall survival was 60·1 per cent (104 of 173). There was a trend towards an increasing number of fenestrations in the graft design over time. In-hospital mortality appeared higher when more complex stent-grafts were used (8 versus 2 per cent for stent-grafts with 3-4 versus fewer than 3 fenestrations; P = 0·059). Graft-related endoleaks were more common following deployment of stent-grafts with three or four fenestrations (12 of 90 versus 6 of 83; P < 0·001).

Conclusion: Fenestrated endovascular aneurysm repair for juxtarenal aneurysm is associated with few aneurysm-related deaths in the long term. Significant numbers of secondary interventions are required, but the majority of these can be performed using an endovascular approach.

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Figures

Figure 1
Figure 1
Percentage of stent‐grafts with each number of target vessels by calendar year
Figure 2
Figure 2
Freedom from mortality (all‐cause) following fenestrated endovascular aneurysm repair in a single UK centre
Figure 3
Figure 3
Freedom from type I or III endoleak following fenestrated endovascular aneurysm repair in a single UK centre in relation to number of fenestrations in stent‐graft. P < 0·001 (log rank test)
Figure 4
Figure 4
Freedom from secondary intervention following fenestrated endovascular aneurysm repair in a single UK centre in relation to number of fenestrations in stent‐graft. P = 0·508 (log rank test)
See this image and copyright information in PMC

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