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Interactive Poster Session

(IP029) Role of Open Surgery as an Adjunct or Bailout in Visceral and Renal Artery Incorporation for Fenestrated/Branched Endovascular Aortic Repair

Thursday, June 5, 2025
5:00 PM - 6:30 PM CT

    Submitting & Presenting Author(s)

  • Abdul Kader Natour, MD

    Resident
    Mayo Clinic
    Rochester, Minnesota

    • Co-Author(s)

  • Armin Tabiei, MD

    Ted Rogers Fellow
    Mayo Clinic
    Rochester, Minnesota

  • Jill J. Colglazier, MD

    Assistant Professor of Vascular Surgery
    Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
    Rochester, Minnesota

  • Randall R. Demartino, MD

    Associate Professor of Surgery
    Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
    Rochester, Minnesota

  • Gustavo S. Oderich, MD

    Vascular Surgeon, Professor of Surgery
    Division of Vascular and Endovascular Surgery, University of Texas Health Science Center, Houston
    Houston, Texas

    • Senior Author(s)

  • Bernardo C. Mendes, MD

    Professor of Surgery
    Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
    Rochester, Minnesota

Objectives: To describe indications and outcomes of open surgery performed for visceral and renal artery incorporation and revascularization prior to, during, or after fenestrated/branched endovascular aortic repair (F/BEVAR).

Methods: Retrospective review of patients who underwent F/BEVAR for complex abdominal (CAAAs) and thoracoabdominal aortic aneurysms (TAAAs) between 2007-2024 was conducted. Patients who underwent open surgical revascularization for superior mesenteric (SMA), celiac (CA) and/or renal arteries (RA) as part of a planned or bailout procedure to the F/BEVAR were included. Access-related procedures, such as open surgical conduits, were excluded. Descriptive analysis was done to illustrate indications and outcomes of these hybrid procedures.

Results: A total of 861 patients underwent F/BEVAR during the study period, of whom 22 (2.5%) had a hybrid procedure and were included. Average age was 76±6 years (range 63-89), and 59% were male. Most of the hybrid repairs were done in patients with TAAAs (17, 77%) and electively (20, 91%). Three (14%) interventions were performed preoperatively, while 19 were performed intra- (3, 14%) or post-operatively (16, 72%). Preoperative hybrid intervention included ilio-renal bypass with syndactilization due to multiple small accessory RA diameter in two patients, and ilio-SMA bypass for chronic mesenteric ischemia in one. Indication for post-F/BEVAR interventions included inability to cannulate target arteries (13, 59%), and complications from target artery dissection (3, 14%) or thrombosis (3, 14%). Most interventions were done during the index admission (15, 68%), and included RA bypasses (8, 36%), retrograde SMA stenting (5, 24%), SMA bypasses (4, 18%), retrograde RA access and stenting (4, 18%), and CA ligation due to complex endoleak in one patient (4%). Technical success was achieved in all cases, with one patient experiencing a postoperative complication (retroperitoneal hematoma requiring evacuation). Mean post-operative length of hospital stay was 15±13 days. At a mean follow-up of 27 months (range 0-108 months), primary patency rates of bypass grafts and stented target arteries via hybrid approach were 100% and 95%, respectively. Overall freedom from target artery related reintervention was 95%, with only one patient requiring RA re-stenting. Freedom from aortic related mortality was 100%. Finally, among 12 patients who had hybrid RA intervention, one patient with solitary kidney that required retrograde access required permanent dialysis.

Conclusions: Open surgical intervention is rarely necessary prior to, during, or after F/BEVAR. Nevertheless, when performed, it proves to be a useful adjunct to incorporate difficult anatomy, and as a bailout procedure providing satisfactory long-term target artery patency with minimal risk.