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Ticketed Event
Ticketed Event

International Plenary

IFT07 - Long-term results of elective endovascular repair of complex aortic aneurysms by custom-made fenestrated endografting

Friday, June 6, 2025
7:25 AM – 7:30 AM CT
Location: Morial CC, Second Floor, Room 224
Objectives: To report the outcomes of elective endovascular repair of complex aortic aneurysms (CAAAs) by custom-made fenestrated endografts (FEVAR).

Methods: It was an observational single-center retrospective study. All consecutive CAAAs (juxta-renal: JAAAs; para-renal: PAAAs, Crawford’s extent-IV thoracoabdominal: type-IV TAAAs) managed electively by FEVAR (Cook-Medical, Bloomington, IN, US) from 2014 to 2024 were analyzed. Outcomes were reported according to the Society for Vascular Surgery reporting standards. Target arteries (TAs) loss, spinal cord ischemia (SCI) and 30-day/in-hospital mortality were assessed as early outcomes. Survival, freedom from reinterventions (FFRs), TAs-instability and aneurysm sac changes were assessed during follow-up.

Results: Out of 457 advanced endovascular aortic procedures, FEVAR was electively performed in 255(56%) CAAAs (JAAAs:145-57%; PAAAs:65-25%; type-IV TAAAs:45-18%). Endograft with < 2, 3 and >4 fenestrations were adopted in 42(16%), 62(24%) and 151(60%) cases, respectively. Overall, 872 TAs were accommodated by 8x8mm (378-43%) and 6x6mm/6x8mm (494-57%) fenestrations. Modified-preloaded system, inverted limb and iliac branch devices were planned in 73(29%), 28(11%) and 50(20%) cases, respectively. Eight (3%) patients experienced TAs-loss within 30-day (8/872 TAs:1%; renal arteries:7; celiac trunk:1). One (0.4%) case of SCI (permanent paraplegia in type-IV TAAA) occurred. Twenty-two (9%) patients required reinterventions within 30-day (access-related:9; iliac-related:5; TAs-related:8). There were 6(2%) deaths within 30-day or during a prolonged/complicated hospitalization. Reinterventions within 30-day was an independent risk-factor (P=0.01;OR:12;95%CI:1.6-89.2) for 30-day/in-hospital mortality. The mean follow-up was 65+32 months. Estimated 5-year FFRs and TAs-instability was 79% and 94%, respectively. Type-IV TAAAs had lower FF TAs-instability than J/PAAAs at 5-year (Type-IV:84% vs J/PAAAs:89%; Log-rank: P= <.001) and it was confirmed as independent risk-factor at the Cox-Regression (P:0.03;HR:5.2; 95%CI:1.7-15.5). Estimated 5-year survival was 70%. Out of 209 patients with available radiological follow-up at 1-year, aneurysm shrinkage, stability and enlargement occurred in 117(56%), 75(36%) and 17(8%) cases, respectively. Cases with shrinkage had higher follow-up survival at 5-year than cases without shrinkage (shrinkage:75% vs no-shrinkage:61%; Log-rank: P=0.04). Cases with TAs-instability had lower follow-up survival at 5-year than cases without TAs-instability (TAs-instability:60% vs no TAs-instability:70%; Log-rank: P=0.004). TAs-instability was an independent risk-factor for follow-up mortality at the Cox-Regression (P:0.01;HR:2.5; 95%CI:1.2-5.2).

Conclusions: Elective endovascular repair of CAAAs by FEVAR is effective with excellent early outcomes and satisfactory long-term results in terms of TAs-instability, reinterventions and survival. Type-IV TAAAs is a risk-factor for TAs-instability, which is associated with lower late survival. The follow-up of FEVAR procedures in patients with type-IV TAAAs should focus on the early detection and correction of TAs-instability.