Monocentric Comparative Study of Conventional Surgery and Endovascular Treatment with Fenestrated Stentgrafts to Treat Juxtarenal and Pararenal Aneurysms of the Abdominal Aorta

Abstract

To compare the surgical risk, the early mortality, and the late survival of patients operated electively for juxtarenal or pararenal (JRA) aneurysms with fenestrated stentgrafts (FSG) with those of patients treated by conventional surgery over a period when the two treatments were available. Between January 2005 and December 2014, we retrospectively included all the patients electively treated in our center for a JRA by excluding the type IV thoraco-abdominal aortic aneurysms. JRAs were classified in three anatomical categories according to a classification described in the literature. We compared the clinical and radiological data of the patients treated by fenestrated stentgraft (ENDO group) with those treated by conventional surgery (OPEN group). Preoperative surgical risk was measured by the ASA score and the clinical score of Lee. We then compared the surgical risk, the morbi-mortality at 30 days, and the survival at 5 years. One hundred and seventy patients were included, 125 in the OPEN group and 45 in ENDO group. The patients of the OPEN group were significantly younger (OPEN 69 years vs. ENDO 74 years, p=0.001). The anatomical distribution of the JRA did not differ between the two groups. ASA score and the score of Lee were significantly higher in the ENDO group (score of Lee ≥1, OPEN 50.4% vs. ENDO 68.9%, p=0.032; score of Lee≥2, OPEN 8.8% vs. ENDO 22.2%, p=0.019; ASA score ≥3 OPEN 32.8% vs. ENDO 75.6%, p<0.0001). The duration of hospitalization in reanimation was significantly longer in the OPEN group (3.4 days vs. 1.5, p=0.01). Mortality at 30 days was not significantly different between the two groups (OPEN 1.6% vs. ENDO 0%, p=0.394). Survival at 5 years was significantly higher in the OPEN group (OPEN 83% vs. ENDO 75%, p=0.003). After adjustment for age survivals were not significantly different (p=0.240). In this study, the conventional surgical treatment of JRA was majority. In spite of a higher surgical risk of the patients treated by FSG postoperative mortality was not significantly different between the two groups. The results of this study show that endovascular treatment with fenestrated stentgrafts and conventional surgery of the juxtarenal aneurysms can be used in a complementary way.