Skip to main content
2025 Vascular Annual Meeting Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
Ticketed Event
Ticketed Event

Interactive Poster Session

(IP005) Comparative Outcomes of FB-EVAR and Explantation for the Management of Failed Infrarenal Endovascular Aortic Repair

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

    Submitting & Presenting Author(s)

  • Armin Tabiei, MD

    Ted Rogers Fellow
    Mayo Clinic
    Rochester, Minnesota

    • Co-Author(s)

  • Richards T. T. Rogers, MD

    Fellow
    Mayo Clinic
    Rochester, Minnesota

  • Manju Kalra, MBBS

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

  • Bernardo C. Mendes, MD

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

  • Todd E. E. Rasmussen, MD

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

  • MS

    Melinda S. S. Schaller

    Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MInnesota
    Rochester, Minnesota

  • Jill J. Colglazier, MD

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

  • Fahad Shuja, MBBS

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

    • Senior Author(s)

  • Randall R. Demartino, MD

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

Objectives: Management of failed infrarenal endovascular aortic repair represents a complex clinical problem. Alternatives include fenestrated/branched endovascular aortic repair (FB-EVAR) and stent graft explantation. This study aimed to compare the safety and effectiveness of FB-EVAR and explantation in this setting.

Methods: Data from patients with infrarenal EVAR failure, managed with either FB-EVAR or explantation from January 2002 to July 2024 was retrospectively analyzed. Patients with endograft infections (n=60) who underwent explantation were excluded from this study. Outcome measures included 30-day mortality, freedom from reintervention, overall survival and freedom from aortic-related mortality (ARM).

Results: Of 156 patients identified, 81 (52%) underwent explantation and 75 (48%) underwent FB-EVAR. FB-EVAR patients were older (77 ± 9 vs 73 ± 8 years, p=.016) with higher rates of coronary artery disease, hypertension, COPD, CHF and peripheral artery disease (Table I). Patients that underwent explantation more often presented with aortic rupture and required emergent repair (12.3% vs 1%, p=.01). FB-EVAR more often underwent elective repair of non-ruptured aneurysms (93% vs 73%, p= <.001). Aneurysm degeneration to Crawford extent I-IV thoracoabdominal aortic aneurysms (TAAAs) were more common in the FB-EVAR group while juxtarenal/pararenal and infrarenal aortic aneurysms (complex abdominal aortic aneurysms) were more common in the explant group. Visceral/renal artery debranching was performed in 18 patients (22%) at explantation. Any major adverse event (MAE) occurred in 33 patients (41%) in the explant group and 17 patients (23%) who underwent FB-EVAR (p=.017), and 30-day mortality occurred in five patients (6%) in the explant group and one patient (1%) in the FB-EVAR group (p=.21). Mean follow-up was longer in the explant group (46 ± 40 vs 33 ± 28 months, p=.019). Four years freedom from reintervention rates (Fig 1) were significantly lower in the FB-EVAR group (53% vs 88%, p= <.001). Overall survival (66%; explant vs 61%; FB-EVAR, p=.43) and freedom from ARM (94%; explant vs 93%; FB-EVAR, p=.67) were similar. The independent predictor of any MAE was symptomatic or ruptured aneurysm (hazard ratio, 6.7; 95% confidence interval 2.4-20.6). The independent predictor of reintervention was extent I-IV TAAA (hazard ratio, 3.4; 95% confidence interval 1.4-8.3). Among complex abdominal aortic aneurysms only, freedom from reintervention was also significantly lower in the FB-EVAR group (39% vs 90%, p= <.001).

Conclusions: Explantation and FB-EVAR both remain viable options in the treatment of failed infrarenal endovascular aortic repair with similar overall and aortic related survival. Patients that undergo FB-EVAR require close surveillance secondary to high reintervention rates.