Fenestrated and branched endovascular aortic repair (F-BEVAR) has been increasingly performed using the supraceliac aorta for sealing zone with 4-vessel incorporation to decrease rates of late branch-related complications from progression of aortic disease. The aim of this study was to investigate outcomes of F-BEVAR using supraceliac sealing zone to treat pararenal (PRA) and thoracoabdominal aortic aneurysms (TAAAs). A total of 100 patients (75 male, mean age 78 ± 7 years old) with PRA and TAAAs were enrolled in a prospective, nonrandomized single-center study using manufactured F-BEVAR (November 2013-October 2015; ClinicalTrials.gov NCT1937949/02089607). Stent design was based on supraceliac sealing zones in all patients, with ≥4 vessels in 97 using a patient-specific or off-the-shelf endograft. Spinal cord injury (SCI) prevention was done using permissive hypertension (mean arterial pressure >80 mm Hg), cerebrospinal fluid drainage, neuromonitoring, and selective use of iliofemoral conduits for all patients with >4 cm of supra celiac coverage. Staged repair was used for all Type I-II TAAAs. Follow-up included clinical examination, laboratory studies, duplex ultrasound, and computed tomography imaging at discharge, 1 month, 6 months, and yearly. An independent data safety monitoring board and clinical event committee was used to adjudicate events. End points were mortality, major adverse events (MAEs), freedom from reintervention, branch vessel occlusion, type Ia/III endoleak, sac aneurysm enlargement, and aneurysm rupture. Aneurysm extent included 37 PRAs, 35 type IV, and 28 type I-III TAAAs, with mean diameter of 65 ± 8 mm. A total of 387 renal-mesenteric arteries were incorporated by 276 fenestrations, 98 branches, and 13 scallops, with mean of 3.9 ± 0.6 vessels/patient. Technical success of target vessel stenting was 99% (385 of 387). There were no 30-day or in-hospital deaths, dialysis, or conversions. MAEs occurred in 19 patients, with an identical rate for PRAs and TAAAs (19% each, Table). Three patients had SCI (2 paraplegia, 1 paraparesis), of which two had complete reversal. Mean length of hospital stay was 5 ± 3 days. Follow-up was >30 days in all patients, >6 months in 75 and >12 months in 51. There were no patients lost to follow-up. After a mean follow-up of 9 ± 4 months, there were 13 reinterventions, 5 type Ia/III endoleaks, 4 renal stent occlusions, 4 late unrelated deaths, 2 sac enlargements, and no ruptures. F-BEVAR using supraceliac sealing zones and 4-vessel designs is safe and can be performed with excellent early outcomes. Long-term follow-up is needed to assess the impact of more extensive 4-vessel designs on late device-related complications and progression of aortic disease.TablePararenal aneurysms (n = 37)Thoracoabdominal aneurysms (n=63)P value30-day outcomesNo. of events and percent Any MAE719719.99Any cause mortality0000–Myocardial infarction3835.7Acute kidney injury2523.58Respiratory failure0023.27Spinal cord injury1323.13Blood loss >1 liter13711.131-year Kaplan-Meier estimatesNo. of events and percent survival ± standard deviation Patient survival493 ± 60100.86 Freedom from reintervention589 ± 6883 ± 7.87 Freedom from type Ia/III endoleak297 ± 2398 ± 2.86 Freedom from vessel occlusion (n = 387)399 ± 2199 ± 2.99 Freedom from sac growth199 ± 2199 ± 2.99MAE, Major adverse event Open table in a new tab