Outcomes Following Fenestrated Endovascular Aortic Repair for Failed Infrarenal Endovascular Aortic Repair Compared With Primary Fenestrated Endovascular Aortic Repair

Fenestrated endovascular aortic repair (FEVAR) is a potential treatment option in patients with failed EVAR due to proximal disease progression. However, studies evaluating the outcomes after FEVAR prior are limited data from single-center and high-volume institutions. Therefore, we compared vs without any surgery (primary FEVAR). We identified undergoing elective for complex abdominal aneurysm Vascular Quality Initiative between 2014 2022 included those who underwent no (n = 2362) or 117). Perioperative 5-year mortality were analyzed using logistic regression Cox models. Sac changes assessed based on differences sac diameter 1-year computed tomography scan preoperative imaging categorized as (>5 mm decrease), stability (<5 change size), expansion increase) analysis. 2362 primary 117 EVAR. The older (76 [72-82] years 74 [68-79] years; P < .001), less frequently female (12% 23%; .004), had larger diameters (68 [60-80] 58 [55-63] mm; more comorbidities. After patients, likely undergo repairs at centers performed by surgeons (P .001). Furthermore, involved zones higher number of branches longer procedural time radiation (all .05). Despite these differences, showed comparable perioperative relative (Table I). FEVAR, group, rates lower (24% 51%; .005), whereas was (39% 7.3%; .001) group II). At 2-year follow-up, associated similar (26% 19%; hazard ratio: 1.4, 95% confidence interval: 0.84-2.2; .20) reinterventions (14% 13%; 1.04, 0.36-3.0; .91) FEVAR. has risk rate 1 year raises significant concerns about durability repairs. may benefit closer surveillance even consideration open conversion. Future should evaluate conversion an alternative failure EVAR.Table IPerioperative EVARPrimary 2373)FEVAR 130)P valueFEAVR FEVARP valueUnadjusted rates, %Adjusteda OR [95% CI]Perioperative death2.82.3.800.62 [0.13-2.2].50Any complication9.611.770.65 [0.29-1.4].30 Stroke0.60.66NANA AKI1214.700.75 [0.38-1.4].4 Postoperative dialysis1.72.3.740.73 [0.10-3.28].71 Bowel ischemia1.91.51.01.4 [0.18-6.2].71 Spinal cord ischemia1.53.1.270.85 [0.11-4.0].85 Leg ischemia1.92.3.740.68 [0.10-3.0].65 Pulmonary complications3.64.6.620.70 [0.21-2.0].52 Cardiac complications3.53.81.00.53 [0.14-1.6].30 Completion type 1A endoleak3.40.8.120.32 [0.02-1.73].29Reintervention during index hospitalization4.26.2.380.73 [0.48-1.1].12Unadjusted %P valueAdjusteda HR CI]P value2-year reintervention1314.201.04 [0.36-3.0].912-year mortality1926.701.4 [0.84-2.2].20AKI, Acute kidney injury; CI, interval; EVAR, repair; fenestrated EVAR; HR, ratio; OR, odds ratio.aAdjusted age, gender, (>65 mm), hypertension, diabetes, myocardial infarction, chronic obstructive pulmonary disease, obesity, anemia, sealing zone, center volume, physician volume. Open table new tab Table IISac dynamics 853), %FEVAR 33), valueSac regression, >5 mm5124.005Stable sac, <5 mm4232.67Sac expansion, mm7.339<.001EVAR, Endovascular EVAR.Boldface value represents significance .05.