Comparative analysis of bridging stent outcomes in fenestrated and branched endovascular aortic aneurysm repair.

Abstract

This study aimed to evaluate associations between bridging stent graft (BSG) type, anatomic location, and midterm primary patency across different BSGs used for fenestrated/branched endovascular aortic aneurysm repair (F/BEVAR). We retrospectively reviewed 321 patients who underwent elective and urgent F/BEVAR between November 2007 and December 2022 at a single academic institution. All repairs involved custom or off-the-shelf devices targeting the renal and mesenteric arteries using BSGs selected at the operator's discretion. BSGs included Atrium Advanta V12, Gore Viabahn, Gore Viabahn VBX Balloon Expandable Endoprosthesis, Bard LifeStream, and Bentley BeGraft Peripheral. The primary outcome was BSG primary patency at 5 years. Secondary end points included primary-assisted and secondary patency, overall target-vessel instability, and assessment of factors associated with primary patency loss. Among the 321 patients (76.9% male, median age 76 years), 1171 BSGs were deployed. Overall technical success was 89.7%, with in-hospital mortality of 5.6%. At 5 years, estimated primary, primary-assisted, and secondary patency rates were 80.5%, 85.8%, and 90.0%, respectively, with 68.7% freedom from target-vessel instability (log-rank P < .001). Primary patency by BSG type was: Advanta V12 94.6%, Viabahn 93.9%, VBX 91.6%, LifeStream 76.7% at 5 years, and 95.1% for BeGraft Peripheral at 2 years (P < .0001). On multivariable analysis, use of LifeStream stents was independently associated with higher odds of primary patency loss (odds ratio [OR]: 3.83, 95% confidence interval [CI]: 2.05-7.04, P < .001), and both left (OR: 2.39, 95% CI: 1.19-5.13) and right (OR: 2.26, 95% CI: 1.10-4.94) renal artery targets demonstrated lower primary patency compared with mesenteric vessels. No significant differences in primary patency rates were observed between fenestrations and branches. In this single-center series of over 1100 BSGs with up to 15 years of follow-up, BSG type and anatomic location were associated with reduced primary patency. LifeStream stents and renal arteries were associated with loss of primary patency, whereas BeGraft Peripheral showed promising early outcomes. These findings support the need for continued surveillance after F/BEVAR and highlight the need for further research to define optimal stent selection strategies.