Fenestrated/branched endovascular aortic repair after failed endovascular aortic repair has similar perioperative outcomes to primary repairs
Recommended Citation
Halabi M, Chamseddine H, Shepard A, Nypaver T, Weaver M, Peshkepija A, Boules T, Kavousi Y, Onofrey K, and Kabbani L. Fenestrated/Branched endovascular repair after failed endovascular aortic repair has similar perioperative outcomes to primary repairs. J Vasc Surg 2025.
Document Type
Article
Publication Date
6-3-2025
Publication Title
Journal of vascular surgery
Abstract
OBJECTIVE: To evaluate the outcomes of fenestrated-branched endovascular aneurysm repair (FB-EVAR) in patients undergoing reintervention for failed EVAR compared with those undergoing primary FB-EVAR.
METHODS: Patients undergoing FB-EVAR between 2014 and 2024 were identified in the Vascular Quality Initiative 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 (EL) (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 FB-EVAR after failed EVAR, and 1681 (81.4%) underwent primary FB-EVAR. In the failed EVAR group, perioperative mortality (3.1% vs 4%; P = .934) and rates of type I/III endoleaks (6.5% vs 8.6%; P = .164) were comparable with that of no prior EVAR. At the 12-month follow-up, mortality rates remained similar (17.2% vs 15.8%; P = .265), However, patients with prior EVAR had a significantly higher reintervention rates (hazard ratio, 1.60; 95% confidence interval, 1.10-2.35; P = .015), despite similar mortality and EL rates.
CONCLUSIONS: FB-EVAR is a safe and effective reintervention strategy after failed EVAR, achieving similar mortality and EL outcomes compared with primary FB-EVAR. However, the significantly higher reintervention rates in patients with prior EVAR may be related to the increased complexity this population.
Medical Subject Headings
FB-EVAR after failed EVAR; Failed EVAR; Fenestrated-branched EVAR
PubMed ID
40473001
ePublication
ePub ahead of print
Volume
82
Issue
5
First Page
1574
Last Page
1580
