How Long Is Too Long? The Impact of Procedural Time on Fenestrated-Branched Endovascular Aortic Repair Outcomes

Document Type

Conference Proceeding

Publication Date

7-1-2026

Publication Title

J Vasc Surg

Keywords

abdominal aortic aneurysm, cerebrovascular accident, clinical outcome, conference abstract, conversion to open surgery, endovascular aneurysm repair, female, heart infarction, human, incidence, intestine ischemia, kidney ischemia, major clinical study, mortality, operation duration, perioperative complication, pneumonia, spinal cord ischemia, surgery, thoracic aorta aneurysm, thoracoabdominal aorta aneurysm

Abstract

Objectives: Fenestrated-branched endovascular aortic repair (F-BEVAR) is a complex procedure that requires significant experience and advanced technical proficiency. This study evaluates the association of operative efficiency and clinical outcomes following F-BEVAR for the treatment of complex and thoracoabdominal aortic aneurysms (TAAAs). Methods: Patient undergoing three- and four-vessel F-BEVAR for intact complex abdominal aortic aneurysms (cAAA) and TAAA between January 2014 and September 2024 were identified in a prospective, nationwide, multicenter registry. cAAA were defined as juxta-, para-, and supra-renal abdominal aortic aneurysms. Outcomes were analyzed as continuous functions of operative time. The primary outcome was major adverse events (MAEs) defined as the composite outcome of mortality, spinal cord ischemia, visceral ischemia, renal ischemia, myocardial infarction, stroke, dialysis, pneumonia, and conversion to open surgery. Secondary outcomes included aortic reintervention and the individual components of the MAE composite measure. Results: A total of 5540 patients underwent F-BEVAR, of which 2956 underwent three- and four-vessel F-BEVAR. Of those, 64.4% (n = 1901) were treated for cAAA and 35.6% (n = 1055) for TAAA. The overall mean incidence of MAE was 21.2% (n = 626), and the median operative time was 240 minutes (interquartile range [IQR], 196-316 minutes). The incidence of MAEs was lowest at 8.4% (95% confidence interval [CI], 7.6%-9.2%) at shorter operative durations and remained relatively stable up to 210 to 240 minutes. Beyond this range, MAE rates increased progressively with longer operative times, reaching a maximum of 29.1% (95% CI, 27.5%-30.7%) at 540 minutes (Fig 1). Rates of spinal cord ischemia remained stable at 3.0% (95% CI, 2.6%-3.3%) through 210 to 240 minutes, after which they rose to 8.0% (95% CI, 7.8%-8.2%) at 540 minutes (Fig 2). Renal and intestinal ischemia similarly remained lowest through 210 to 240 minutes, after which renal ischemia increased from 1.3% (95% CI, 0.9%-1.8%) to a maximum of 4.8% (95% CI, 4.4%-5.2%), while intestinal ischemia increased from 0.5% (95% CI, 0.3%-0.9%) to a maximum of 2.2% (95% CI, 2.0%-2.3%). Other perioperative complication rates also rose with prolonged operative times, including aortic reintervention (from 2.3% to 7.3%) and mortality (from 0.5% to 3.4%). Conclusions: Prolonged operative time longer than 240 minutes is associated with significantly worse perioperative outcomes following F-BEVAR for cAAA and TAAA repair. While technical precision remains essential, it should not come at the expense of procedural efficiency. Surgeons who are unable to perform F-BEVAR within the acceptable operative timeframe should consider seeking intraoperative assistance or referring those patients to high-volume centers with demonstrated favorable outcomes. [Formula presented] [Formula presented]

Volume

84

Issue

1

First Page

e79

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