ORIGINAL ARTICLE  THE FATE OF AORTA AFTER ENDOVASCULAR ANEURYSM REPAIR 

The Journal of Cardiovascular Surgery 2019 April;60(2):159-66

DOI: 10.23736/S0021-9509.19.10872-5

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Rescue of proximal failure of endovascular abdominal aortic aneurysm repair with standard and fenestrated grafts

Pablo MARQUES de MARINO, Rafael D. MALGOR, Eric L. VERHOEVEN, Athanasios KATSARGYRIS ✉

Department of Vascular and Endovascular Surgery, General Hospital Nuremberg, Paracelsus Medical University Nuremberg, Nuremberg, Germany

BACKGROUND: This study aimed to assess the outcomes of standard and fenestrated grafts to treat proximal failure of previous endovascular aneurysm repair (EVAR) in a tertiary referral center.
METHODS: All patients undergoing elective implantation of a standard or fenestrated graft after proximal failure of a previous EVAR between April 2010-November 2018 were included. Data were collected prospectively.
RESULTS: Fifty procedures were performed in 49 patients (45 male; mean age 74.6±7 years). A fenestrated proximal cuff was used in 24 (48%) cases, a composite bifurcated configuration in 21 (42%) cases, and EVAR in 5 (10%) cases. Technical success was achieved in all 5 EVAR cases and 41 of 45 FEVAR cases (91.1%). Iliac artery access problems due to the presence of the previous graft were encountered in eight (16%) procedures and renal artery catheterization difficulties in grafts with suprarenal fixation in seven (15.6%) procedures. There was one (2%) early death due to retroperitoneal bleeding. Early major complications occurred in three (6%) patients. Median follow-up was 26 months (range 1-77). Late occlusion occurred in two (1.3%) of the 151 targeted vessels. One patient needed permanent dialysis. Nine patients died during follow-up, one (2%) of them aneurysm-related. Ten (20.4%) patients presented with major complications during follow-up of which nine (18.4%) needed reintervention. Estimated freedom from reintervention at 1 and 3 years was 89.3±5.1% and 78.8±7.3%, respectively.
CONCLUSIONS: Repair with fenestrated grafts represents a safe and effective treatment option. Increased technical challenges are to be expected due to the previous graft.

KEY WORDS: Aortic aneurysm, abdominal - Endovascular procedure - Endoleak