The Midterm Results of Fenestrated and Branched Aneurysm Repair of Previous Failed Fenestrated EVAR

Abstract

© 2020 Elsevier Inc. Background: The purpose of this study was to report the feasibility and midterm outcomes of a redo-fenestrated and/or branched endovascular aortic repair (re-F/BEVAR) to rescue failed previous FEVAR. Methods: Consecutive patients undergoing re-F/BEVAR were reviewed retrospectively. Electronic databases, clinical data, all imaging studies, and initial stent-graft planning were reviewed to assess causes of initial stent-graft failure and outcomes of re-F/BEVAR. Data are presented as median and interquartile range. Results: Five of 221 (2.2%) patients receiving an FEVAR between 2007 and 2015 underwent re-F/BEVAR between 2012 and 2016 (52 (34–80) months postoperatively). An unsuitable initial proximal sealing zone for the original FEVAR had been chosen in all patients. The failures motivating re-F/BEVAR became apparent as type Ia endoleaks (3 isolated and 1 combined with graft migration) and a graft migration associated with significant proximal aortic expansion (1 patient). The median operative time was 206 (202–378) minutes and technical success was achieved in all cases. Two patients received staged procedures. No perioperative death or spinal cord ischemia occurred. During a follow-up of 37 (22–56) months, 2 patients underwent late reinterventions, 1 patient required 1 reintervention, and 1 patient required 4 reinterventions including a type III endoleak with rupture. Secondary success could be achieved in all cases. There were 2 non–aneurysm-related deaths. Conclusions: Late FEVAR failure is rare and follows poor initial graft planning. Re-F/BEVAR is technically demanding but the midterm outcomes are acceptable even if reinterventions are needed in some patients. Re-F/BEVAR represents a valuable approach to rescue failed FEVAR but the findings need to be confirmed on a larger scale preferably with a multicenter contribution.