Postoperative Outcomes and Reinterventions Following Fenestrated/Branched Endovascular Aortic Repair in Post-Dissection and Complex Degenerative Abdominal and Thoraco-Abdominal Aortic Aneurysms

Abstract

Background: The outcome of FBEVAR in post-dissection thoracoabdominal aortic aneurysms has not been well established in the literature. The aim of this study was to compare midterm outcomes following FBEVAR in post-dissection aneurysms to degenerative aneurysms. (2) Methods: This was a retrospective review of all patients undergoing FBEVAR in a single center between 2017 and 2020. The baseline characteristics, intraoperative details, and postoperative outcomes of patients with post-dissection aneurysms were compared to those with degenerative outcomes. The primary end point was unplanned reinterventions. Cox regression analysis was performed to identify the determinants of worse outcomes. Results: A total of 137 subjects with a mean age of 70 ± 10 years were included in the study, out of which 30 presented post-dissection aneurysms (22%). Custom-made devices were employed in 119 patients, off-the-shelf devices in 13 and physician-modified endografts in 5, with incorporation in 505 target vessels. The technical success rate was comparable in both groups (97% vs. 98%, p = 0.21). However, the one-year freedom from unplanned reintervention was lower in the post-dissection group (67% vs. 89%, p = 0.011). Conclusion: FBEVAR in post-dissection aneurysms is associated with a favorable technical success rate, but reintervention rates remain high. Long procedural duration and the use of adjunctive techniques are associated with increased risk of reinterventions.

Keywords

• fenestrated endovascular aortic repair
• branched endovascular aortic repair
• thoracoabdominal aortic aneurysms
• complex aortic aneurysms
• FEVAR
• BEVAR