SS03. Results of Fenestrated and Branched Endovascular Aortic Aneurysm Repair After Failed Infrarenal Endovascular Aortic Aneurysm Repair

Abstract

Failure of infrarenal endovascular aortic aneurysm repair (EVAR) owing to loss of proximal seal is increasingly common. Open surgical conversion is challenging and associated with significant morbidity/mortality. The aim of this study was to evaluate the use of fenestrated/branched endovascular aortic repair (F/BEVAR) for the treatment of patients with prior EVAR failure. Consecutive patients enrolled in six, prospective, nonrandomized, physician-sponsored investigational device exemption studies evaluating F/BEVAR between 2012 and 2018, were included in this study. The cohort was stratified according to whether the F/BEVAR procedure was performed after EVAR failure. Demographics, operative details, perioperative complications, and length of stay were compared between groups. Patient survival, type I or type III endoleak, target artery patency, and reintervention rates were calculated using Kaplan-Meier method and compared between groups. A total of 893 patients underwent F/BEVAR; 161 (18%) were treated after failed EVAR and 732 (82%) were treated without prior EVAR. Patients with failed EVAR were more often men (84% vs 66%; P < .01) with larger aneurysms (6.9 cm vs 6.4 cm; P < .01). There were no differences in aneurysm extent (P = .20) between the groups: 19% juxtarenal, 9.2% suprarenal, and 72% thoracoabdominal. The average number of targeted arteries per patient was 3.6 in both groups. The procedural technical success (99% vs 97%; P = .15) did not differ between groups, but radiation dose (4753 mGy vs 2924 mGy; P = .02), dose area product (154,572 mGy cm2 vs 82,842 mGy cm2; P < .01), and operative time (5.2 hours vs 4.6 hours; P < .01), were significantly higher in the failed EVAR group. Median intensive care length of stay (2.9 days) and total length of stay (6.3 days) did not differ between groups. The 30-day mortality rate (failed EVAR, 2.5%; no EVAR, 1.1%; P = .25) and 30-day major adverse event rate (Fig 1) did not differ between groups. Kaplan-Meier estimates of freedom from death (88.3% vs 92.5%; P = .10; Fig 2), type I or type III endoleak (91.9% vs 92.5%; P = .65), target artery occlusion (97.3% vs 97.0%; P = .91), and reintervention at 1 year (84.7% vs 88.7%; P = .10) did not differ between the failed EVAR and no EVAR group, respectively. In this multicenter study, F/BEVAR was safe and effective in patients with prior failed EVAR, with nearly identical outcomes as compared with patients without prior EVAR. However, differences in procedural metrics indicate higher level of technical challenge when performing F/BEVAR in patients with prior failed EVAR.Fig 2Kaplan-Meier estimates of freedom from death. EVAR, Endovascular aortic aneurysm repair.View Large Image Figure ViewerDownload Hi-res image Download (PPT)