IP071. Comparison of Fenestrated Endovascular and Open Surgical Repair for Suprarenal and Type IV Thoracoabdominal Aortic Aneurysms∗

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The aim of this monocentric retrospective study was to compare outcomes of fenestrated endovascular aneurysm repair (FEVAR) and open surgical repair (OR) of suprarenal abdominal aortic aneurysms and type IV thoracoabdominal aneurysms (TAAAs). Consecutive patients undergoing elective FEVAR and OR of suprarenal and type IV TAAAs between January 2012 and November 2015 were included. Choice between FEVAR and OR was based on anatomic criteria and the patient’s comorbidities. In the OR group, an extracorporeal circulation was systematically used to provide oxygenated isothermic blood to the renal and the visceral arteries during aortic clamping. During the study period, 26 patients underwent FEVAR and 26 underwent OR. Patients in the FEVAR group were significantly older (FEVAR, 74 ± 8 years; OR, 67 ± 8 years; P < .001) and had a lower preoperative glomerular filtration rate (FEVAR, 63 [47-81] mL/min/1.73 m2; OR, 77 [64-87] mL/min/1.73 m2; P = .049). Univariate analysis showed no difference in terms of 30-day mortality (FEVAR and OR groups, 2/26 [7.7%]). Moderate to severe complication rates were 54% (14/26) in the FEVAR group and 65% (17/26; P = .4) in the OR group. Permanent paraplegia occurred in one (4%) FEVAR patient and two (8%) OR patients. In the FEVAR group, two (8%) patients required permanent dialysis. In the OR group, four (15%) patients required transient dialysis. The mean follow-up time was 37 ± 20 months after FEVAR and 35 ± 18 months after OR. At 24 months, the actuarial survival rate was significantly higher in the OR group (FEVAR group, 62%; OR group, 92%; log-rank test, P = .03), and estimated freedom from reintervention rates (FEVAR vs OR group, 64% vs 64%; log-rank test, P = .63) were not significantly different between both groups. In this study, no significant difference in terms of postoperative mortality, complication, and reintervention rates could be identified between FEVAR and OR for suprarenal and type IV TAAAs. OR provided good midterm results.