The Midterm Results of Fenestrated and Branched Aneurysm Repair of Previous Failed Fenestrated EVAR

Abstract

The purpose of this study was to report the feasibility and midterm outcomes of a redo-fenestrated and/or branched endovascular aortic repair (re-F/BEVAR) to rescue failed previous FEVAR. Consecutive patients undergoing re-F/BEVAR were reviewed retrospectively. Electronic databases, clinical data, all imaging studies, and initial stent-graft planning were reviewed to assess causes of initial stent-graft failure and outcomes of re-F/BEVAR. Data are presented as median and interquartile range. Five of 221 (2.2%) patients receiving an FEVAR between 2007 and 2015 underwent re-F/BEVAR between 2012 and 2016 (52 (34-80) months postoperatively). An unsuitable initial proximal sealing zone for the original FEVAR had been chosen in all patients. The failures motivating re-F/BEVAR became apparent as type Ia endoleaks (3 isolated and 1 combined with graft migration) and a graft migration associated with significant proximal aortic expansion (1 patient). The median operative time was 206 (202-378) minutes and technical success was achieved in all cases. Two patients received staged procedures. No perioperative death or spinal cord ischemia occurred. During a follow-up of 37 (22-56) months, 2 patients underwent late reinterventions, 1 patient required 1 reintervention, and 1 patient required 4 reinterventions including a type III endoleak with rupture. Secondary success could be achieved in all cases. There were 2 non-aneurysm-related deaths. Late FEVAR failure is rare and follows poor initial graft planning. Re-F/BEVAR is technically demanding but the midterm outcomes are acceptable even if reinterventions are needed in some patients. Re-F/BEVAR represents a valuable approach to rescue failed FEVAR but the findings need to be confirmed on a larger scale preferably with a multicenter contribution.