Perioperative outcome of fenestrated and branched stent grafting after previous open or endovascular abdominal aortic repair

Makaloski, V.; Tsilimparis, N.; Panuccio, G.; Spanos, K.; Wyss, T.R.; Rohlffs, F.; Debus, E.S.; Kölbel, T. (2021). Perioperative outcome of fenestrated and branched stent grafting after previous open or endovascular abdominal aortic repair. Annals of vascular surgery, 74, pp. 229-236. Elsevier 10.1016/j.avsg.2020.12.047

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Aim: To compare the perioperative outcome of patients treated with elective or urgent fenestrated and branched stent grafting (fbEVAR) for pararenal (pAAA) and thoraco-abdominal aortic aneurysm (TAAA) after previous open with previous endovascular abdominal aortic repair.

Methods: Single center retrospective analysis of all patients undergoing fbEVAR after previous open (post-open fbEVAR group) or endovascular abdominal aortic repair (post-endo fbEVAR group) between January 2015 and December 2017. Primary outcomes were technical success and in-hospital all-cause mortality.

Results: We identified 42 patients undergoing fbEVAR after previous open or endovascular abdominal aortic repair during this period. Twenty-one patients (post-open fbEVAR group) had previous open abdominal aortic repair, 13 with a bifurcated and eight with a tube graft. Of these, two patients presented with pAAA and 19 with TAAA. Twenty-one patients (post-endo fbEVAR group) had previous EVAR. Thirteen patients presented with pAAA, three of them with additional type Ia endoleak, two with stent-graft migration and two with previously failed fEVAR. Eight presented with TAAA. Median interval between previous repair and fbEVAR was 84 months (IQR 60-156) for the post-open fbEVAR group and 72 months (IQR 36-96) for the post-endo fbEVAR group (P=0.746). Eighteen patients (86%) had branched stent grafting in the post-open vs. eleven (52%) in the post-endo group (P<0.01). In two patients in the post-open group, three renal arteries were not catheterized due to severe ostial stenosis, resulting in technical success of 91% in the post-open and 100% in the post-endo fbEVAR group. Four patients (19%) in the post-open fbEVAR group died in hospital, two due to cerebral haemorrhage and two due to pneumonia, and none in the post-endo fbEVAR group (P=0.101). There were five non-stent-graft-related re-interventions, two (10%) in the post-open fbEVAR group and three (14%) in the post-endo fbEVAR group (P=0.844). After 12 months there were four events in the post-endo fbEVAR group: one renal artery stent occluded, one renal artery stent required relining because of disconnection and two type II endoleaks were embolized with coils. There were no re-interventions in the post-open fbEVAR group during 12 months.

Conclusion: Fenestrated and branched repair after previous open or endovascular abdominal aortic repair appears safe with high technical success rate. There is no difference in the technical success and in-hospital all-cause mortality rates between fbEVAR after previous open or endovascular abdominal aortic repair.

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