5-year Outcomes of Fenestrated and Branched Endovascular Repair of Complex Aortic Aneurysms Based on Aneurysm Extent

Objectives To evaluate the 5-year outcomes of fenestrated/branched endovascular aortic repair (F/BEVAR) for the treatment of complex aortic aneurysms stratified by the aneurysm extent. Methods Patients with the diagnosis of complex aortic aneurysm, who underwent F/BEVAR at a single center were included in this study and retrospectively analyzed. The cohort was divided according to the aneurysm extent, comparing group 1 (types I-III thoracoabdominal aneurysms-TAAA), group 2 (type IV TAAA), and group 3 (juxtarenal, pararenal, or paravisceral aortic aneurysms - JRAA, PRAA, PVAA). The primary endpoints were 30-day and 5-year survival. The secondary endpoints were technical success, occurrence of spinal cord ischemia, primary patency of the visceral arteries, freedom from target vessel instability, and secondary interventions. Results Of 436 patients who underwent F/BEVAR between July 2012 and May 2023, 131 presented with types I-III TAAA, 69 with type IV TAAA, and 236 with JRAA, PRAA, or PVAA. All cases were treated under a physician-sponsored IDE protocol with a patient-specific company-manufactured or off-the-shelf device. Group 1 had significantly younger patients than group 2 or 3 respectively (69.6 ± 8.7 vs 72.4 ± 7.1 vs 73.2 ± 7.3, P < .001) and had a higher percentage of females (50.4% vs 21.7% vs 17.8%, P < .001). Prior history of aortic dissection was significantly more common among patients in group 1 (26% vs 1.4% vs 0.9%, P < .001), and mean aneurysm diameter was larger in group 1 (64.5 vs 60.7 vs 63.2 mm, P = .033). Comorbidities were similar between groups, except for coronary artery disease (P < .001) and tobacco use (P = .003), which were less prevalent in group 1. Technical success was similar in the three groups (98.5% vs 98.6% vs 98.7%, P > .99). The 30-day mortality was 4.5%, 1.4%, and 0.4%, in groups 1, 2, and 3, respectively, and was significantly higher in group 1 when compared to group 3 (P = .01). The incidence of spinal cord ischemia was significantly higher in group 1 compared to group 3 (5.3 vs 4.3% vs .4%, P = .004). The 5-year survival was significantly higher in group 3 when compared to group 1 (P = .01). Freedom from secondary intervention was significantly higher in group 3 when compared to group 1 (P = .003). At 5 years, there was no significant difference in freedom from target vessel instability between groups or primary patency in the 1652 target vessels examined. Conclusions Larger aneurysm extent was associated with lower 5-year survival, higher 30-day mortality, incidence of secondary interventions, and spinal cord ischemia. The prevalence of secondary interventions in all groups make meticulous follow-up paramount in complex aortic aneurysm patients treated with F/BEVAR.