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Long-term Outcomes after FEVAR for Juxtarenal Aortic Aneurysm

Published:November 24, 2021DOI:https://doi.org/10.1016/j.jvs.2021.11.050

      ARTICLE HIGHLIGHTS

      • Type of Research: Single-center retrospective cohort study
      • Key Findings: Treatment with fenestrated endovascular aneurysm repair for juxtarenal abdominal aortic aneurysms in 94 patients resulted in 89.4% technical success, 89% target vessel patency at 5 years, 70 reinterventions in 37 (39.4%) patients, 71% 5-year all cause survival.
      • Take home Message: Long-term outcome after treatment of juxtarenal abdominal aortic aneurysms with fenestrated endovascular aneurysm repair remains good and the treatment is safe and effective, although the need for reintervention remains high.
      • Table of Contents Summary
      • Long-term target vessel patency and over-all survival was good in this retrospective study of 94 patients treated with fenestrated endovascular aneurysm repair for juxtarenal abdominal aortic aneurysms. Early detection of target vessel instability may reduce the need for reinterventions.

      Abstract

      Objective

      Fenestrated endovascular aortic repair (FEVAR) for juxtarenal aortic aneurysm (jAAA) disease is safe and effective with good short- and mid-term outcomes. Durability issues focus mainly on proximal and distal seal as well as target vessel (TV) instability, and long-term data is scarce. In previous publications we have reported short-term outcomes after FEVAR while comparing early- and late-experience patient groups, as well as long-term results for the early cohort. In this series we provide long-term outcome in the late experience cohort treated with FEVAR in Vascular Center Malmö.

      Methods

      Consecutive patients treated in Vascular Center Malmö with FEVAR for jAAA between 2007 and 2011 were included. Data was collected retrospectively from medical- and imaging records. Follow up consisted of a clinical examination 1 month post-operatively, and computed tomography angiography combined with plain abdominal X-ray at 1 and 12 months, and annually thereafter. Primary endpoints were TV instability, reinterventions and survival. Changes in aneurysm diameter and renal function as well as endoleaks were also analyzed.

      Results

      94 patients were treated. Median follow-up time was 89 (range 0-152) months. 280 fenestrations or scallops were employed of which 205 were stented. Technical success was 89.4%. Primary TV patency was 94% ± 1 % at 1year, 90% ± 2% at 3 years and 89% ± 2% at 5 years. 37 (39.4%) patients needed a total of 70 reinterventions and mean time to first reintervention was 21 ± 3.97 months. 5 (5.3%) patients died of aneurysm related causes and overall survival was 95.7% ± 2.1% at 1 year, 87.1% ± 3.5% at 3 years and 71.0 ± 4.7% at 5 years. A stable or decreasing aortic diameter after treatment was seen in 91% of cases. Mean glomerular filtration rate (GFR) fell from 59.2 ± 14.9 ml/min/1.73m2 pre-operatively to 50.0 ± 18.6 ml/min/1.73 m2 at end of follow-up.

      Conclusion

      Long-term results after treatment of jAAA with FEVAR remain good and the treatment is safe and effective. Although the need for reintervention remains high, long-term renal function and survival support the use of FEVAR as a valid treatment option for jAAA disease.

      Key words

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