IF07. The Impact of Branches and Fenestrations on Early and Long-Term Visceral Vessel Patency in Complex Aortic Endograft Revascularization

Abstract

Aortic endograft treatment with fenestrated or branched devices requires a connection between the aortic graft and the visceral vessel (VV); however, data on the perioperative and long-term fate of the VV are still scarce. The aim of our study was to evaluate VV loss (VVL) according to the type of revascularization performed (fenestrations vs branched) and adjunctive visceral procedures (AVPs) necessary. From 2012 to 2017, all fenestrated or branched endovascular repairs of juxtarenal aortic aneurysms (JAAAs), pararenal aortic aneurysms (PAAAs), and thoracoabdominal aortic aneurysms (TAAAs) were considered. Perioperative VVL, AVPs, and graft configuration were considered and evaluated during the follow-up. There were 523 VVs considered, 26% (140) in JAAAs, 32% (165) in PAAAs, and 42% (218) in TAAAs. Branches were used for 114 (52%) vessels in TAAAs, 8 (5%) in PAAAs, and 0 in JAAAs. The overall perioperative VVL was 24 (4.5%), and it was significantly higher in TAAAs compared with JAAAs or PAAAs (8.3% vs 2.4% vs 1.4%; P = .003). Branches had higher perioperative VVL compared with fenestration, 13% (15/123) vs 2% (9/401). This was confirmed selectively in TAAAs (5% [5/96] vs 0% [0/94]; P = .02). A significant VVL difference between branches and fenestrations (21% [11/52] vs 2.5% [(6 /224]; P = .001) was shown only by renal arteries. AVPs were performed in 43 (8.2%) VVs for dissections (0.4%-2%), stenosis (0.6%-3%), bleeding (0.6%-3%), or kinking (7%-35%); a significant difference between branches and fenestrations was seen only for kinking (12% [15/112] vs 5% [20/401]; P = .005). At 5 years, VVL was 2% ± 1%; fenestrations showed significantly higher VVL-free survival compared with branches (100% vs 87% ± 6%; P = .04), and this was confirmed selectively for TAAAs (100% vs 87% ± 6%; P = .04). AVPs did not affect the long-term visceral patency. Early and late VVL is infrequent in complex aortic procedures but seems to occur more frequently in branches compared with fenestrations, specifically in renal arteries. AVPs are often required to correct artery kinking, but this does not affect long-term patency.