Original Article   

The Journal of Cardiovascular Surgery 2022 Sep 14

DOI: 10.23736/S0021-9509.22.12311-6

Copyright © 2022 EDIZIONI MINERVA MEDICA

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