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REVIEW  OUTCOMES AND CHALLENGES IN MODERN AAA REPAIR 

The Journal of Cardiovascular Surgery 2018 April;59(2):213-24

DOI: 10.23736/S0021-9509.18.10341-7

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Durability of fenestrated endovascular aortic repair for juxta-renal abdominal aortic aneurysm repair

Konstantinos SPANOS 1 , George Α. ANTONIOU 2, Athanasios D. GIANNOUKAS 3, Fiona ROHLFFS 1, Nikolaos TSILIMPARIS 1, Sebastian E. DEBUS 1, Tilo KÖLBEL 1

1 German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, Hamburg, Germany; 2 Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK; 3 Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece


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BACKGROUND: The aim of this study was to evaluate the long term durability of fenestrated endovascular aortic aneurysm repair (F-EVAR) of juxta-renal aortic aneurysms (JAAAs) in terms of mortality, target visceral vessel (TVV) patency and Reintervention rates.
EVIDENCE ACQUISITION: A systematic review and meta-analysis was performed. MEDLINE, CENTRAL, and Cochrane databases were searched with PRISMA methodology for studies reporting on F-EVAR of JAAA presenting follow-up >36 months. Articles with <15 patients, follow-up <36 months, comparison of F-EVAR with other treatment modalities were excluded.
EVIDENCE SYNTHESIS: Seven non-randomized retrospective studies of prospectively collected data were analysed including 772 patients (mean age and diameter ranging from 71.5 to 74 years and from 60 to 65mm, respectively) underwent F-EVAR for JAAA during 2001-2015. The pooled mortality rates during 12, 24, 36, 48 and 60 months were 0.080 (0.060-0.106), 0.129 (0.097-0.169), 0.211 (0.158-0.277), 0.279 (0.193-0.386) and 0.405 (0.303-0.517), respectively. The pooled Reintervention rates during 12, 24, 36 and 48 months were 0.097 (0.066-0.140), 0.131 (0.082-0.203), 0.281 (0.182-0.406) and 0.244 (0.103-0.477), respectively. The pooled loss of TVV patency rates during 12, 24, 36, 48 and 60 months were 0.046 (0.035-0.060), 0.081 (0.058-0.110), 0.088 (0.060-0.127), 0.123 (0.067-0.214) and 0.132 (0.081-0.207).
CONCLUSIONS: F-EVAR for the treatment of patients with JAAA is a durable procedure with good long term outcomes in terms of mortality and visceral vessels patency. During long term period the need for a Reintervention continues to exists, thus follow-up of those cases may be important for preserving the good results.


KEY WORDS: Cardiovascular surgical procedures - Aortic aneurysm, abdominal - Review

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