Affordable Access

deepdyve-link
Publisher Website

Results of fenestrated and branched endovascular aortic aneurysm repair after failed infrarenal endovascular aortic aneurysm repair.

Authors
  • Schanzer, Andres1
  • Beck, Adam W2
  • Eagleton, Matthew3
  • Farber, Mark A4
  • Oderich, Gustavo5
  • Schneider, Darren6
  • Sweet, Matthew P7
  • Crawford, Allison8
  • Timaran, Carlos9
  • 1 Division of Vascular and Endovascular Surgery, University of Massachusetts Medical School, Worcester, Mass. Electronic address: [email protected]
  • 2 Division of Vascular and Endovascular Surgery, University of Alabama at Birmingham, Birmingham, Ala.
  • 3 Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass.
  • 4 Division of Vascular and Endovascular Surgery, University of North Carolina, Chapel Hill, NC.
  • 5 Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
  • 6 Division of Vascular and Endovascular Surgery, Weill Cornell Medical College, New York, NY.
  • 7 Division of Vascular and Endovascular Surgery, University of Washington, Seattle, Wash.
  • 8 Division of Vascular and Endovascular Surgery, University of Massachusetts Medical School, Worcester, Mass.
  • 9 Division of Vascular and Endovascular Surgery, University of Texas Southwestern, Dallas, Tex.
Type
Published Article
Journal
Journal of vascular surgery
Publication Date
Sep 01, 2020
Volume
72
Issue
3
Pages
849–858
Identifiers
DOI: 10.1016/j.jvs.2019.11.026
PMID: 32144014
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Failure of infrarenal endovascular aneurysm repair (EVAR) due to loss of proximal seal is increasingly common. Open surgical conversion can be challenging and has been associated with significant morbidity and mortality. The aim of this study was to evaluate the use of fenestrated-branched EVAR (F/BEVAR) for the treatment of patients with prior EVAR failure. Consecutive patients enrolled as part of the Aortic Research Consortium in six prospective, nonrandomized, physician-sponsored investigational device exemption studies evaluating F/BEVAR between 2012 and 2018 were included in this study. The cohort was stratified according to whether the F/BEVAR procedure was performed after EVAR failure. Demographics, operative details, perioperative complications, and length of stay were compared between groups. Postprocedural survival, type I or type III endoleak, target artery patency, target artery instability, and reintervention rates were calculated using Kaplan-Meier method and compared between groups. A total of 893 patients underwent F/BEVAR; 161 (18%) were treated after failed EVAR and 732 (82%) were treated without prior EVAR. Patients with failed EVAR were more often men (84% vs 66%; P < .01) with larger aneurysms (6.9 cm vs 6.4 cm; P < .01). There were no differences in aneurysm extent (P = .20) between groups; for the entire cohort, there were 19% juxtarenal, 9.2% suprarenal, and 72% thoracoabdominal aneurysms. The average number of targeted arteries per patient was 3.6 in both groups. The procedural technical success (99% vs 97%; P = .15) did not differ between groups, but radiation dose (4750 vs 2920 mGy; P = .02), dose-area product (154,572 vs 82,842 mGy·cm2; P < .01), and operative time (5.2 vs 4.6 hours; P < .01) were significantly higher in the failed EVAR group. Median intensive care unit length of stay (2.9 days) and total length of stay (6.3 days) did not differ between groups. The 30-day mortality rate (failed EVAR, 2.5%; no EVAR, 1.1%; P = .25) and 30-day major adverse event rates did not differ between groups. Kaplan-Meier estimates of freedom from type I or type III endoleak (91.9% vs 92.5%; P = .65), target artery patency (97.3% vs 97.0%; P = .91), freedom from target artery instability (86.3% vs 88.8%; P = .53), and freedom from reintervention at 1 year (84.7% vs 88.7%; P = .10) did not differ between the failed EVAR and no EVAR groups, respectively. One-year survival was decreased in the failed EVAR group (86.3% vs 91.9%; P = .02), but this effect did not persist on multivariable analysis (hazard ratio, 1.52; 95% confidence interval, 0.88-2.62; P = .14). In this multicenter study, F/BEVAR was safe and effective in patients with prior failed EVAR, with nearly identical outcomes to those of patients without prior EVAR. However, differences in procedural metrics indicate higher level of technical challenge in performing F/BEVAR in patients with prior failed EVAR. Copyright © 2019 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Report this publication

Statistics

Seen <100 times