Early Experience with Fenestrated Endovascular Compared to Open Repair of Complex Abdominal Aortic Aneurysms in a High-Volume Open Aortic Center

Abstract

Early data suggest that fenestrated endovascular aneurysm repair (FEVAR) is feasible but may have higher morbidity and unclear durability compared to open surgical repair (OSR) of complex abdominal aortic aneurysms (CAAAs). We compared the early experience following elective FEVAR to traditional OSR of CAAA in a high-volume open aortic center. All patients undergoing FEVAR and OSR for elective CAAA from 1/2010-7/2015 were identified. Univariate, multivariable logistic, and Cox hazards modeling were used to compare perioperative and intermediate outcomes. We identified 116 patients who underwent CAAA repair (18 FEVAR) with a median follow-up of 26months. FEVAR patients had higher rates of congestive heart failure (22% vs. 5.1%; P=0.03). Operative time was slightly longer following FEVAR (282 vs. 240min, P=0.02). There was no difference in 30-day operative mortality (0% in both) or major complications. Median intensive care unit (0 vs. 3days; P<0.001) and hospital length of stay (2.5 vs. 7days; P<0.001) were shorter after FEVAR. Rates of 30-day graft complications (5.6% FEVAR vs. 5.1% OSR, P=1.0) were similar, and there was no statistically significant difference in rates of graft complications in follow-up (17% vs. 8.2%, P=0.37). After multivariable modeling, FEVAR patients were more likely to develop late graft-related complications (hazard ratio [HR]; 5.0, 95% confidence interval [CI]: 0.98-25). Kaplan-Meier 1-year survival was similar (100% vs. 92%), even after multivariable adjustment (HR, 0.6; 95% CI: 0.1-5.0). Early experience in FEVAR at a high-volume open aortic center shows that FEVAR can be performed safely with comparable perioperative risk to OSR. FEVAR may be associated with graft complications during follow-up, which should be considered in clinical decision-making. Further study is warranted to better elucidate late durability of FEVAR and the impact of the learning curve on outcomes.