Nationwide outcomes of Fenestrated Endovascular Aneurysm Repair.

Abstract

Fenestrated endovascular aneurysm repair (FEVAR) is increasingly used in patients who are not eligible for standard EVAR devices due to anatomical constraints, principally of the proximal aortic neck. The long-term outcomes of FEVAR are not well described and therefore the aim of this study was to perform an analysis of a national registry in the United Kingdom. The UK GLOBALSTAR registry (2003-2022) was analysed to report the long-term outcomes for FEVAR. Patients were included if they underwent FEVAR with custom made or off the shelf devices for infradiaphragmatic aortic aneurysmal disease. Paitents with thoracoabdominal aneurysms or those who revievied standard EVAR were excluded. Time-to-event analyses were conducted for survival, aneurysm-related mortality, re-intervention, endoleak and target vessel patency. Subgroup analyses were conducted for octogenarians and patient sex. Some 1651 patients across 15 centres were included. The median age was 75 years [Q1-Q3, 69-79] and 87.9% were male. Estimated survival at 3, 5 and 10 years was 79.5% [95%CI,77.6-81.5%], 64.1% [95%CI,61.7-66.6%] and 30.5% [27.7-33.5%]; median survival was 6.9 years [95%CI,6.6-7.2]. Aneurysm-related mortality was 6.7% at 10 years [95%CI,5.4-8.0%]. There were 36 secondary sac ruptures over follow-up. The cumulative incidence of re-intervention at 3, 5 and 7 years was 21.5% [95%CI,19.5-23.6%], 25.6% [95%CI,23.3-27.8%] and 27.6% [95%CI,25.3-30.0%]. Graft-related complications accounted for 73.9% of re-interventions. Women had significantly worse 2-year survival (81.1%, [95%CI,75.8-86.7%]) than men (86.1%, [95%CI,84.3-87.9%]) (p= 0.04), driven by an increased peri-operative mortality. Beyond 2 years, the differences in survival were not statisically significant. Octogenarians had equivalent survival (89.4% [95%CI,86.4-92.4%]) to non-octogenarians (92.1% [95%CI,90.7-93.6%]) up to 1 year (p=0.07). Octogenarians' median survival was 5.4 years [95%CI,5.0-6.1]. Long-term outcomes for FEVAR appear acceptable, with low rates of secondary sac rupture. Re-intervention following FEVAR carries significant risks of re-intervention and these are principally driven by graft-related complications suggesting effective graft surveillance is key to long-term durability.