Salvage of Failing Abdominal Aortic Aneurysm Repairs with Fenestrated Endovascular Aortic Repair

Background

Fenestrated endovascular aortic repair (FEVAR) can be used for salvage of failing abdominal aortic aneurysm (AAA) repairs. We describe our experience with the commercially available Zenith fenestrated (ZFEN) platform to salvage failing AAA repairs.

Methods

This is a retrospective review of all FEVARs performed from January 2012 until August 2019 at a tertiary academic medical center. The study compared primary FEVAR against reoperative FEVARs (RFEVAR) done for salvage of prior infrarenal aneurysm repairs with 60 months of follow-up. The primary outcome was technical success. Secondary outcomes included mortality, reintervention, and complications.

Results

There were 153 patients meeting inclusion criteria, with 133 primary repairs and 20 RFEVARs. Indications for repair included proximal disease progression (55%) and type IA endoleak (45%). Primary FEVARs were associated with decreased case complexity, with shorter operative time (217.6 vs. 265.6 minutes, P = 0.018) and number of visceral arteries stented (2.2 vs. 2.6, P = 0.021). Technical success was 97.7% in the primary FEVAR group, versus 95.0% in the RFEVAR group (P = 0.43). At 60 months, estimated survival and freedom from reintervention did not differ between groups and were 68.8% (P = 0.38) and 76.0% (P = 0.80), respectively, in the RFEVAR group.

Conclusion

RFEVAR using ZFEN is effective to salvage failing AAA repairs, with 60-month outcomes comparable to primary repair of AAA using FEVAR. RFEVAR is attractive over traditional open approaches as it avoids significant morbidity. These results support the long-term efficacy of ZFEN to salvage failing aortic repairs.