Mid-term Results of Fenestrated/Branched Aneurysm Repair of Previous Failed Fevar

Abstract

Introduction: Failure of the proximal seal after fenestrated endovascular aneurysm repair(FEVAR) is a rare but very complex complex situation. Proximal extension of failing infrarenal EVAR is currently a well established method. This situation becomes much more complex if the viscera-renal segment has already been incorporated in the initial repair. The aim of this study is to report the feasibility and mid-term outcomes of a redo fenestrated/branched endovascular aortic repair (re-F/BEVAR) to rescue failed previous FEVAR. Methods: Consecutive patients undergoing re-F/BEVAR in a single center were reviewed retrospectively. Electronic databases, clinical data, all imaging studies and initial stent graft planning were reviewed to assess causes of initial stentgraft failure and outcomes of re-F/BEVAR. Data is presented as median and interquartile range. Results: Five out of 221 (2.2 %) patients receiving a FEVAR between 2007 and 2015 underwent re-F/BEVAR between 2012 and 2016 (52 (34 - 80) months postoperatively). The failure was caused by type Ia endoleak (n = 3), graft migration (n = 1) or a combination of both (n=1). On review, a suboptimal landing zone for the first FEVAR was identified in all cases. Median operative time was 206 (202-378) minutes and technical success was achieved in all cases. Two patients received staged procedures (2 and 15 months postoperatively). No perioperative death or spinal cord ischemia occurred. During a follow-up of 37 (22 - 56) months, 2 patients required 1 reintervention including the late second stage and 1 patient required 4 reinterventions including a type III endoleak with rupture. Secondary success could be achieved in all case. There were 2 non-aneurysm-related deaths. Conclusion: Late FEVAR failure is rare and follows poor initial graft planning. Re-F/BEVAR is technically demanding but mid-term outcomes are acceptable even if reinterventions are needed in some patients. Re-F/BEVAR represents a valuable approach to rescue failed FEVAR. This results need to be confirmed in larger studies preferably with multicenter contribution. Disclosure: Timothy Resch and Nuno V. Dias are consultants, speakers, receive research support and hold IP with Cook Medical Inc. Nuno V. Dias is a consultant for Siemens Healthineers. Other authors declare no conflict of interest.