Concomitant Parallel Endografting and Fenestrated Experience in a Regional Aortic Center

Abstract

Off-label parallel endografting (PE) has been increasingly criticized in favor of on-label custom fenestrated endografts. There remain limited direct comparisons, however, between concurrent patient populations treated by similarly experienced operators. Hence, we seek to evaluate the relative efficacy of the two techniques in treating complex aortic pathology. All patients treated by PE or with Cook Zenith Fenestrated (Zfen) devices from January 2010 to June 2015 were reviewed, excluding those treated for rupture. Patients were all evaluated for open repair as well as for fenestrated devices since its availability at our center in July 2013. Patients predating fenestrated access or not meeting anatomic indications for use criteria and preferring endovascular therapy were treated with PE. A total of 93 patients were treated during the period reviewed, 54 (58.1%) by PE and 39 (41.9%) with Zfen. The two procedures required similar length of surgery (234min PE vs. 239 min Zfen), blood loss (634cc vs. 409cc), and length of stay (median 6days). PE, however, was associated with less fluoroscopy time (52.8 vs. 64.6min) and contrast volume (103.5cc PE vs. 133cc Zfen). At mean 202days follow-up, Zfen has required three reinterventions (two type III endoleaks and one superior mesenteric artery stenosis causing mesenteric ischemia) and there have been zero branch vessels lost. At mean 427days follow-up, PE patients experienced three stent occlusions (one repaired endovascularly) and required eight additional interventions (two type I endoleaks, two type II endoleaks with sac growth, two type III endoleaks, one graft infection, and one aneurysm rupture). Reintervention rates for PE and Zfen were 17.6% and 7.7%, respectively, with branch patency rates of 98% and 100%. PE and fenestrated repair offer similarly high branch patency and technical success. PE performed for juxtarenal aneurysms has similar reintervention rate to fenestrated repair. The two techniques have similar length of stay, operative time, and blood loss, but fenestrated repair is associated with greater fluoroscopy time and contrast usage.