Back to 2025 Abstracts
Differences In Aortic Remodeling In Patients With Type Ia And Type V Endoleak Who Undergo Salvage With F/BEVAR
Trung Nguyen, DO1, Eric Finnesgard, MD
2, Shivam Patel, BS
1, Andrew Matar, MD
1, Murray Shames, MD
1, Jean Bismuth, MD
1, Salvatore Scali, MD
3, Andres Schanzer, MD
2, Dean J. Arnaoutakis, MD, MBA
1.
1University of South Florida, Tampa, FL, USA,
2University of Massachusetts, Worcester, MA, USA,
3University of Florida, Gainesville, FL, USA.
Objective: Aneurysm sac growth following endovascular aortic aneurysm repair (EVAR) is multifactorial. A specific cause of growth (eg type 1a endoleak, (EL1a)) may be present or may be absent (no observed endoleak resulting in type 5 endoleak (EL5)). Salvage of EL1a with fenestrated/branched EVAR (F/BEVAR) to obtain supraceliac seal is a viable strategy to achieve sac stability or regression. In patients with EL5, it remains unknown whether F/BEVAR leads to a similar outcome. We sought to determine the incidence rate of sac stability or regression following F/BEVAR for EL1a versus EL5.
Methods: Prospective databases from two complex aortic centers were retrospectively queried to identify all patients who underwent F/BEVAR for failed EVAR (2015-2024). Patients were categorized to have either EL1a or EL5 based on preoperative CT scan. Pre-, intra-, and post-operative variables were compared between the groups. The primary composite outcome, sac stability(≤5mm change) or regression(>5mm decrease), was calculated using Kaplan-Meier method.
Results: A total of 102 patients (75 with EL1, 27 with EL5), with a mean age of 78±6.6 years and large aneurysms (71±16.2mm) were studied; no significant intergroup preoperative characteristic differences were observed. F/BEVAR repairs incorporated 3.8±0.5 target arteries. Fluoroscopy dose, contrast volume, procedure time, blood loss, and technical success were similar between groups. Postoperative complication rates (EL1a: n=15, 20% vs EL5: n=4, 15%; p=.77) and 30-day mortality (EL1a: n=1, 1% vs EL5: n=2, 7%; p=.17) were similar. The cumulative incidence of sac stability or regression at 4-years was 92% [95%CI: 83-97%] for EL1a vs 81% [95%CI: 61-94%] for EL5 (log-rank p=.03) (
Figure). On multivariable analysis, the hazard ratio for sac stability or regression was 1.72 [95%CI 1.02-2.89;p=.04] for EL1a compared to EL5.
Conclusions: Sac stability or regression can be achieved in most patients with EL1a or EL5 who undergo endovascular salvage with F/BEVAR. However, those treated for EL5 are less likely to achieve sac stability or regression. Additional data are needed to better understand fundamental differences in these subsets of failed EVAR patients and to better guide appropriate salvage therapy.
Figure. Cumulative incidence of sac stability or regression in F/BEVAR for type Ia endoleak versus type V endoleak
Back to 2025 Abstracts
