Large Fenestrations Versus Scallops For The SMA During Fenestrated EVAR: Does It Matter?

Abstract

<h3>OBJECTIVE</h3> FEVAR is an established customized treatment for aortic aneurysms with two general strategies for the superior mesenteric artery (SMA). Outcomes comparing SMA single-wide scallops to large fenestrations with the commercially available ZFEN device are scarce. We sought to determine the outcomes of seal zone and sac regression between the two SMA configurations. <h3>METHODS</h3> We retrospectively reviewed our prospectively maintained complex EVAR database for all Cook ZFEN patients undergoing SMA scallop or large fenestration configurations. All first post-operative CT scans (1-30 days) were analyzed on Terarecon for proximal seal zone lengths, and standard follow-up anatomic and clinical metrics were tabulated. <h3>RESULTS</h3> A total of 234 consecutive ZFEN patients from 2012-2021 were reviewed, and 137 had either a scallop or large fenestration for the SMA with imaging available for analysis (72 scallops and 65 large fenestrations). Mean follow-up was 35 months. Mean proximal seal zone length was 19.5±7.9 mm for scallop vs 41.7±14.4 mm for large fenestration groups (P<.001). There was no difference in sac regression between scallop and large fenestration at latest follow-up (10.1±10.9 mm vs 11.0±12.1, P=.63) (FIGURE). Percentage of proximal neck reinterventions in the large fenestration group was 1.3% (n=1) and 3.8% (n=3) in the scallop group (P=.33). Overall, 30-day mortality (1.3% vs 2.5%, P=.51) and all-cause three-year mortality (72.5% vs 81.7%, P=.77) were not significantly different.Figure 1Sac Regression at 1 year between two SMA ConfigurationsFigure 1 <h3>CONCLUSION</h3> Despite attaining longer seal lengths, large SMA fenestrations were not associated with a difference in sac regression compared to scalloped SMA configurations. There were no differences in reinterventions or overall long-term mortality between the two SMA strategies.