Early And Midterm Outcomes Of Fenestrated-branched Endovascular Aortic Repair In Patients With Or Without Prior History Of Abdominal Endovascular Or Open Surgical Repair
Andrea Vacirca, MD PhD1, Aidin Baghbani-Oskouei, MD1, Emanuel R. Tenorio, MD PhD1, Ying Huang, MD PhD1, Aleem Mirza, MD PhD1, Naveed Saqib, MD1, Bernardo Mendes, MD PhD2, Gustavo S. Oderich, MD1.
1Department of Cardiothoracic & Vascular Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA, 2Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA.
Objectives: To compare outcomes of fenestrated-branched endovascular aortic repair (FB-EVAR) of complex abdominal (CAAA) and thoracoabdominal aortic aneurysms (TAAA) in patients with and without prior history of abdominal aortic repair. Methods: The clinical data of consecutive patients enrolled in a prospective, non-randomized study to evaluate FB-EVAR for treatment cAAAs and TAAAs was reviewed. We analyzed outcomes in patients with no previous aortic repair (Controls), prior EVAR (Group 1) and prior abdominal open surgical repair (OSR, Group 2), including 30-day mortality and major adverse events (MAEs), patient survival and freedom from aortic-related mortality (ARM), secondary interventions, any type 2 endoleak, sac enlargement (5mm) and new-onset dialysis.Results: There were 502 patients enrolled in the study (70% male, mean 72±9 years-old), including 376 controls, 54 patients who had prior EVAR (Group 1) and 72 patients who had prior abdominal OSR (Group 2). FB-EVAR was performed on average 7±4 and 12±6 years after the prior EVAR and abdominal OSR, respectively. Aneurysm extent was cAAA in 143 patients (29%) and TAAA in 359 patients (72%). Patients had similar characteristics in the three groups, except for less coronary artery disease in controls and more TAAAs and branch stent-graft designs in Group 2 (P<.05). Overall technical success, mortality and MAE rate was 96%, 1% and 28%, respectively, with no difference between groups (Table). Mean follow up was 27±21 months. There was no difference in patient survival and freedom from ARM between groups at 5-years. Group 1 patients had lower freedom from secondary intervention (P=.03), any type 2 endoleak (P=.04) and sac enlargement (P<.001), whereas Group 2 patients had lower freedom from new-onset permanent hemodialysis (P=.04). Conclusions: FB-EVAR was performed with high technical success, low mortality and similar risk of MAEs, regardless of prior history of abdominal aortic repair. There was no difference in
patient survival and freedom from ARM. Patients with prior EVAR had more secondary interventions, and lower freedom from type 2 endoleak and sac enlargement. Patients with prior abdominal OSR had lower freedom from new-onset dialysis.
Table. Outcomes in patients with and without prior abdominal aortic repair
| n (%) | All patients n = 502 | Controls n = 376 | Group 1 n = 54 | Group 2 n= 72 | P value |
| 30-day Mortality | 5 (1%) | 4 (1%) | 0 | 1 (1%) | .71 |
| 30-day Major Adverse Events | 139 (28%) | 101 (27%) | 17 (32%) | 21 (29%) | .75 |
| 5-year Patient survival | 57±5% | 60±5% | 48±15% | 47±10% | .07 |
| 5-year Freedom from ARM | 98±1% | 98±1% | 96±4% | 97±2% | .78 |
| 5-year Freedom from secondary intervention | 63±4% | 64±5% | 50±11% | 64±12% | .03 |
| 5-year Freedom from Type 2 endoleak | 56±4% | 55±4% | 44±11% | 82±7% | .04 |
| 5-year Freedom from aneurysm sac enlargement | 88±3% | 91±3% | 54±13% | 97±2% | <.001 |
| 5-year Freedom from new onset dialysis | 97±1% | 98±1% | 98±2% | 88±6% | .04 |
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