Fenestrated Endovascular Aortic Aneurysm Repair as a First Line Treatment Option to Treat Short Necked, Juxtarenal, and Suprarenal Aneurysms

Abstract

The outcomes of fenestrated endovascular aneurysm repair (FEVAR) as a first line strategy is reported. All consecutive patients treated with FEVAR for short neck, juxtarenal, or suprarenal aortic aneurysms under the guidance of the senior author within the period January 2010 to December 2014 were included. Data were collected from a prospectively maintained database. Analyzed outcomes included technical success, defined by successful stent graft implantation with patent stented target vessels and no Type I/III endoleak, operative mortality and morbidity, target vessel patency, endoleak, re-intervention, and death. Survival, target vessel stent patency, and re-intervention during follow up were calculated by Kaplan-Meier analysis. A total of 281 patients (245 male, mean age 72.1±7.7 years) were treated. The mean aneurysm diameter was 60.2±9.3mm and median proximal neck length 2mm (range 0-10mm). Technical success was 96.8% (272/281). Technical failure included one intra-operative death due to embolization and cardiac arrest, one open conversion due to iliac rupture, and seven target vessel complications. The thirty day mortality was 0.7% (2/281). Mean follow up was 21±15.9 months. Estimated survival at 1 and 3 years was 94.7%±1.6% and 84.6%±3.0%, respectively. Estimated freedom from re-intervention at 1 and 3 years was 96.1%±1.4%, and 90%±2.7%. Estimated target vessel stent patency at 1 and 3 years was 98.6%±0.5%, and 98.1%±0.6%, respectively. Mean aneurysm sac diameter decreased from 60.2±9.3mm pre-operatively to 53.2±12.8mm (p<.001). FEVAR as a first line strategy was associated with high technical success and a low operative mortality rate. Efficacy and durability in the mid-term appear very good, with significant regression of aneurysm sac diameter, high target vessel patency, and acceptable rate of re-intervention.