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Background: Fenestrated endovascular aneurysm repair (FEVAR) has become an alternative in patients unfit for open repair and with morphology not suitable to traditional endovascular aneurysm repair (EVAR). FEVAR requires cannulation and stent placement within visceral vessels that could lead to complications not seen after traditional EVAR, and little is known about the gastrointestinal complications (GIC). This study was performed to determine the prevalence of GIC after FEVAR.
Methods: Over a 5-year period, we prospectively gathered data on 148 patients who underwent FEVAR at our institution.
Results: The median number of vessels fenestrated was 3(IQR:2-4), with a total of 457 vessels. Minor and major GIC occurred in 59(39.9%) patients. There were 2(1.4%) gastrointestinal bleeds, 2(1.4%) patients who developed cholecystitis, 1(0.7%) patient who developed liver failure, and 2(1.4%) patients who developed Clostridium difficile infections. There were no patients who developed pancreatitis, ascites, or small bowel obstructions. Seventy(47.3%) patients had a history of abdominal complaints, and 24(24/70;34.3%) of these developed a GIC. Seventy-two(48.6%) patients had a history of abdominal surgery and 24(24/72;33.3%) developed a GIC. Fifty-five(37.2%) patients developed an ileus, 11(7.4%) requiring a nasogastric tube and 3(2.0%) requiring total parenteral nutrition (TPN). Five(3.4%) patients were taken to the operating room for presumed colonic ischemia, which was confirmed in 2 patients(1.4%) and 1(0.7%) patient was found to have gangrenous cholecystitis. There were no patients who developed small bowel ischemia. The median time to tolerate a diet in the GIC group was 5(IQR:3-6) days. The median ICU stay was significantly higher in the GIC group than in those without complications (5[IQR:3-9]days vs 2[IQR:1-3]days, respectively;P<0.0001). When comparing patients who had a complication based on extent of visceral stenting, there was a higher rate in those who underwent stenting of the celiac artery compared to those that only included the renal arteries (13/40vs27/56;P=0.003) and a higher complication rate comparing above and below the SMA (13/40;32.5%vs46/108;42.6%)(P=0.002). Fourteen(9.5%) patients required re-admission within 30-days, 9(6.1%) for GIC, although none required surgical intervention.
Conclusions: Serious gastrointestinal complications following FEVAR are rare. However, ileus and delayed return of bowel function are common and a major cause of extended hospital stay. Not surprisingly, the level of complexity of FEVAR appears to influence GI complication rates.