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Long-term Outcomes Of Patients With Failed Previous Infrarenal Aortic Repairs Rescued Using Fenestrated Stent-grafts At Centers Without Access To Custom Made Devices
Hamza Hanif, MD
1, Rachel Danczyk, MD
1, LeAnn Chavez, MD, MBA
1, Ross M. Clark, MD, MBA, RPVI
1, Nedaa Skeik, MD, FACP, FSVM, RPVI
2, John Marek
1, Muhammad Ali Rana, MD, FACS, FSVS
1, Jesse Manunga
3.
1University of New Mexico, Albuquerque, NM, USA,
2Minneapolis Heart Institute at Abbott Northwestern Hospital Minneapolis, Minneapolis, MN, USA,
3Minneapolis Heart Institute at Abbott Northwestern Hospital Minneapolis, Minneapolis, NM, USA.
OBJECTIVES: To report outcomes of patients with failed previous infrarenal aortic repairs rescued using fenestrated stent grafts (fEVAR).
METHODS: Retrospective review of prospectively maintained database of patients with failed infrarenal aortic repairs that were rescued with fEVAR between 2013-2024 at two tertiary care centers under senior author’s IDE. Primary endpoint are technical success (completion of fEVAR without open conversion, target vessel loss or type Ia/b/III endoleak), long-term device integrity, and vessel patency. Secondary endpoints included procedural major adverse events (MAEs), long-term aortic related mortality and reintervention.
RESULTS: A total of 51 patients (45 males; age 75±7 years) with failed previous infrarenal aortic repairs (48 EVARs, 3 open) were rescued using fEVAR. Thirty seven (72%) were classified as American Society of Anesthesiologists (ASA) III and 14 (28%) were ASA IV. Failure of primary repair was attributed to disease progression in 36 (70%), short initial neck in 8 (16.3%) patients, and unable to determine in 7 (14%). Three patients were treated emergently for contained rupture. Total of 182 vessels were targeted including 96 renal (RAs), 50 superior mesenteric and 34 celiac arteries and 179 were successful. Twenty-three (53%) patients required relining of the entire aortoiliac segment and in 20 (47%) seal was obtained in the previous aortic graft. Total flourscopy time, radiation dose and estimated blood loss were 74±31 mins, 3.1±2.4 Gy and 340±400 cc, respectively. Two RAs were lost intraoperatively. MAEs occurred in 5 including renal failure in 4, acute mesenteric ischemia and death in 1, compartment syndrome requiring fasciotomy in 1, paralysis and death in 2. Hospital length of stay and ICU length of stay were 3±2 and 1±1 days, respectively. The mean follow-up was 37±22 months, and six patients required re-intervention, all related to visceral stents. There was no aortic-related mortality, 100% device integrity and freedom from major endoleak, 97.3% primary patency and 100% primary assisted patency.
CONCLUSIONS: Failed previous EVAR can be safely rescued with fEVAR with a high technical success and excellent long-term outcomes. fEVAR should be considered as an alternative to open stent-graft explantation in both high and normal surgical risk patients.
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