Comparison of Fenestrated Stentgrafts and Open Repair for Juxtarenal Aortic Aneurysms Using a Propensity Score Matching

Abstract

The purpose of this study was to compare postoperative morbi-mortality and medium-term follow-up of fenestrated stent grafting and open repair (OR) for patients with juxtarenal aortic aneurysms (JRAAs). All consecutive patients who underwent custom-made fenestrated endovascular aortic repair (FEVAR) or OR for complex abdominal aortic aneurysm between 2005 and 2017 in 2 tertiary centers were scrutinized. Patients with JRAA constituted the study group. Suprarenal and thoracoabdominal aortic aneurysms were excluded. The groups were made comparable through the use of a propensity score matching. 277 patients with JRAAs were included, 102 (36.8%) in the FEVAR group and 175 (63.2%) in the OR group, respectively. After propensity score matching, 54 FEVAR patients (52.9%) and 103 OR patients (58.9%) were included for analysis. In-hospital mortality rates were 1.9% (n=1) in the FEVAR group versus 6.9% (n=7) in the OR group (P=0.483). Postoperative complications were less common in the FEVAR group (14.8% vs. 30.7%; P=0.033). Mean follow-up was 42.1months in the FEVAR group and 40months in the OR group. Overall mortality rates at 12 and 36months were 11.5% and 24.5% in the FEVAR group versus 9.1 % (P=0.691) and 11.6% (P=0.067) in the OR group. Late reinterventions were more frequent in the FEVAR group (11.3% vs. 2.9%; P=0.047). However, freedom from reintervention rates were not significantly different at 12months (FEVAR: 86% vs. OR: 90%; P=0.560) and 36months (FEVAR: 86% vs. OR: 88.4%, P=0.690). In the FEVAR group, persistent endoleak during follow-up was identified in 11.3% of cases. In the present study, there was no statistical difference in terms of mortality in-hospital at 12 or 36months between FEVAR and OR groups for JRAA. FEVAR for JRAA was associated with a significant reduction of overall postoperative major complications compared with OR. There were significantly more late reinterventions in the FEVAR group.