Comparing Mobile C-Arm with a Hybrid Operating Room for Imaging in Fenestrated Stent-Graft Endovascular Abdominal Aortic Aneurysm Repair

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To evaluate the advantages of a hybrid operating room (OR) (group 2) compared with a fluoroscopic mobile C-arm (group 1) during fenestrated stent-graft endovascular aneurysm repair (f-EVAR). This single-center study retrospectively analyzed prospectively collected data of consecutive patients treated with f-EVAR for short-necked, juxtarenal, and suprarenal aortic aneurysms between January 2006 and July 2016. Primary end points were technical success and perioperative complications. Secondary end points included 30-day and 1-year mortality as well as target vessel patency. About 96 patients were treated (85 men; 74.1±6.3years); 46 patients (48%) belonging to group 1 and 50 (52%) patients belonging to group 2. Technical success was achieved in 92.7% of the procedures (group 1 91.3% vs. group 2 94%, P=0.72). Significantly more complex interventions were performed in group 2 (n=38 of 50) compared with group 1 (n=14 of 46; P<0.001), in which primarily renal f-EVAR interventions were performed. In group 2, significantly less contrast was used (median 150mL vs. 100mL; P<0.001). The 30-day mortality in group 1 was 9% and 2% in group 2 (P=0.14), and 1-year survival was also not significantly different between both groups. Target visceral vessel primary patency was significantly higher in group 1 (87.6% vs. 85.5% [P=0.006] and 83.8% vs. 78.3% [P=0.03]) at 6 and 12months, respectively). There was no significant difference in renal artery primary patency at 6 and 12months. Immediate and 1-year outcomes after f-EVAR for abdominal aortic aneurysm were comparable using a hybrid OR compared with a mobile C-arm, despite the use of significantly more complex stent grafts in the patients treated in the hybrid OR. The use of a hybrid OR may assist in achieving satisfying results in complex f-EVAR.