Fenestrated/Branched endovascular repair after failed endovascular aortic repair has similar perioperative outcomes to primary repairs.

IF 3.9 2区医学 Q1 PERIPHERAL VASCULAR DISEASE

Journal of Vascular Surgery Pub Date : 2025-06-03 DOI:10.1016/j.jvs.2025.05.205

Mouhammad Halabi, Hassan Chamseddine, Alexander Shepard, Timothy Nypaver, Mitchell Weaver, Andi Peshkepija, Tamer Boules, Yasaman Kavousi, Kevin Onofrey, Loay Kabbani

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引用次数: 0

Abstract

Objective: To evaluate the outcomes of fenestrated-branched endovascular aortic repair (FB-EVAR) in patients undergoing reintervention for failed endovascular aneurysm repair (EVAR) compared to those undergoing primary FB-EVAR.

Methods: Patients undergoing FB-EVAR between 2014 and 2024 were identified in the Vascular Quality Initiative (VQI) database. Patients were then divided into two groups, those undergoing FB-EVAR after failed EVAR and those undergoing primary FB-EVAR. Baseline characteristics, operative details, and outcomes were compared between groups. Primary outcomes included mortality, reintervention, and endoleak (Type I/III) rates. Secondary outcomes included perioperative complications. Kaplan-Meier survival analysis and Cox regression were used to evaluate 1-year outcomes.

Results: A total of 2067 patients were included in this study, 386 (18.6%) underwent F/BEVAR after failed EVAR, while 1,681 (81.4%) underwent primary FB-EVAR. In the failed EVAR group, perioperative mortality (3.1% vs. 4%, p=0.934) and rates of Type I/III endoleaks (6.5% vs 8.6%, p=0.164) were comparable to that of no prior EVAR. At 12-month follow-up, mortality rates remained similar (17.2% vs. 15.8%, p=0.265), However, patients with prior EVAR had a significantly higher reintervention rates (HR 1.60, 95% CI 1.10-2.35, p=0.015), despite similar mortality and endoleak rates.

Conclusion: FB-EVAR is a safe and effective reintervention strategy following failed EVAR, achieving similar mortality and endoleak outcomes compared to primary FB-EVAR. However, the significantly higher reintervention rates in patients with prior EVAR may be related to the increased complexity this population.

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主动脉腔内修复失败后的开窗/分支腔内修复术与初次修复术的围手术期结果相似。

目的：评价再干预失败的血管内动脉瘤修复（EVAR）患者行开窗分支血管内主动脉修复（FB-EVAR）与初次行FB-EVAR患者的预后。方法：在血管质量倡议（VQI）数据库中识别2014年至2024年间接受FB-EVAR的患者。然后将患者分为两组，一组在EVAR失败后接受FB-EVAR，另一组接受原发性FB-EVAR。比较两组患者的基线特征、手术细节和结果。主要结局包括死亡率、再干预和内漏（I/III型）率。次要结局包括围手术期并发症。Kaplan-Meier生存分析和Cox回归用于评估1年预后。结果：本研究共纳入2067例患者，其中386例（18.6%）在EVAR失败后接受了F/BEVAR， 1681例（81.4%）接受了原发性FB-EVAR。在EVAR失败组中，围手术期死亡率（3.1% vs. 4%, p=0.934）和I/III型内漏率（6.5% vs. 8.6%, p=0.164）与无EVAR组相当。在12个月的随访中，死亡率保持相似（17.2%对15.8%,p=0.265）。然而，尽管死亡率和内漏率相似，但既往有EVAR的患者的再干预率明显更高（HR 1.60, 95% CI 1.10-2.35, p=0.015）。结论：在EVAR失败后，FB-EVAR是一种安全有效的再干预策略，与原发性FB-EVAR相比，其死亡率和内漏率相似。然而，既往EVAR患者的再干预率明显较高可能与该人群的复杂性增加有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Vascular Surgery 医学-外科

CiteScore

7.70

自引率

18.60%

发文量

1469

审稿时长

54 days

期刊介绍： Journal of Vascular Surgery ® aims to be the premier international journal of medical, endovascular and surgical care of vascular diseases. It is dedicated to the science and art of vascular surgery and aims to improve the management of patients with vascular diseases by publishing relevant papers that report important medical advances, test new hypotheses, and address current controversies. To acheive this goal, the Journal will publish original clinical and laboratory studies, and reports and papers that comment on the social, economic, ethical, legal, and political factors, which relate to these aims. As the official publication of The Society for Vascular Surgery, the Journal will publish, after peer review, selected papers presented at the annual meeting of this organization and affiliated vascular societies, as well as original articles from members and non-members.