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Original Article   

The Journal of Cardiovascular Surgery 2022 Sep 14

DOI: 10.23736/S0021-9509.22.12311-6


language: English

Impact of stent-graft complexity on mid-term results in fenestrated endovascular aortic repair (FEVAR) of juxtarenal and suprarenal abdominal aortic aneurysms

Ozan YAZAR 1, 2, Gabriela PILZ da CUNHA 1, Michiel W. de HAAN 3, Barend M. MEES 1, Geert W. SCHURINK 1

1 Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, the Netherlands; 2 Department of Vascular Surgery, Zuyderland Medical Center, Heerlen, the Netherlands; 3 Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands


BACKGROUND: The impact of stent-graft complexity on clinical outcome after fenestrated endovascular aortic aneurysm repair (FEVAR) has been conflicting in the literature. The objective of this study was to compare mid-term results of stent-grafts with renal fenestrations alone with more complex stent-grafts including mesenteric fenestrations.
METHODS: A single center retrospective study was conducted on 154 patients, who underwent FEVAR from 2006 to 2020 at our institution.
RESULTS: There were 54 (35.1%) patients in the renal FEVAR group and 100 (64.9%) patients in the complex FEVAR group. Median follow-up of the total group was 25 months (IQR 7-45). There were no significant differences in technical success and perioperative mortality. Intraoperative complications (4% vs. 18%, p = .001), operative time (145 min vs. 191 min, p = .001), radiation dose (119372 mGy*cm2 vs. 159573 mGy*cm2, p = .004) and fluoroscopy time (39 min vs. 54 min, p = .007) were significantly lower in the renal FEVAR group. During follow-up target vessel instability, endoleaks and reinterventions were not significantly different between the two groups.
CONCLUSIONS: In this single center retrospective study, renal FEVAR was a safe and effective treatment for patients with juxtarenal AAA demonstrating fewer intraoperative complications and similar mid-term outcomes as complex FEVAR. If the anatomy is compatible for renal FEVAR, it might be unnecessary to expose patients to potentially more complications by choosing a complex FEVAR strategy.

KEY WORDS: Fenestrated stent-graft; Aneurysm; Renal artery; Juxtarenal; Visceral artery; Endovascular aneurysm repair

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