O-010 - LONG TERM PROPENSITY MATCHED COMPARISON OF FENESTRATED ENDOVASCULAR ANEURYSM REPAIR AND OPEN SURGICAL REPAIR OF COMPLEX ABDOMINAL AORTIC ANEURYSMS

TOPIC:
Abdominal Aortic Aneurysms
AUTHORS:
Tinelli G. (Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy ~ Roma ~ Italy) , Sica S. (Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy ~ Roma ~ Italy) , Sobocinski J. (Aortic Center, CHU Lille, France ~ Lille ~ France) , Ribreau Z. (Aortic Center, CHU Lille, France ~ Lille ~ France) , De Waure C. (Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Perugia, Italy ~ Perugia ~ Italy) , Ferraresi M. (School of Vascular Surgery, University of Milan, Milan, Italy ~ Milano ~ Italy) , Snider F. (Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy ~ Roma ~ Italy) , Tshomba Y. (Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy ~ Roma ~ Italy) , Haulon S. (Aortic Center, CHU Lille, France ~ Lille ~ France)
Introduction:
Open surgical repair (OSR) has been considered the standard of care for complex abdominal aortic aneurysm (c-AAA), but fenestrated and branched endovascular aortic repair (F-BEVAR) currently represents an effective and safe alternative. The impact of these two approaches has been poorly compared specifically in the long-term with regards to overall survival and complications, and particularly the analysis of renal function decline. This study investigated the long-term outcomes of patients treated with F-BEVAR or open surgical repair (OSR) for complex abdominal aortic aneurysms (c-AAAs). This study compares with a propensity score matching the outcome of these procedures from two high-volume aortic centers.
Methods:
All patients with c-AAAs undergoing repair at two centers between January 2010 and June 2016 were included. The long-term imaging follow-up consisted in a yearly computed tomography angiography (CTA) in the F-BEVAR group. Yearly abdominal ultrasound examination and 5-year CTA were performed in the OSR group. The primary endpoints were mortality, aortic-related mortality and chronic renal decline (CRD) during follow-up. Secondary endpoints included aortic-related reinterventions, target vessel occlusion, proximal aorta degeneration, access-related complications, graft infection, cancer during follow-up and the composite end-point of clinical failure.
Results:
After 1:1 propensity matching and exclusion of the in-hospital mortality, the long-term analysis included 98 F-BEVARs and 99 OSRs. The median follow-up was 67 months (IRQ 37). There was no significant difference in long-term overall mortality (37.7% vs 35.3%; p.45), aortic-related mortality (3.1% vs 3%; p.97), clinical failure (12.2% vs 5.1%; p.07), target vessel occlusion (1.0% vs 5.0%; p.21) in the F-BEVAR and OSR, respectively. During follow-up, late renal function decline occurred in 27 (27.8%) vs. 46 patients (47.4%) in the F-BEVAR and OSR groups, respectively (p<.01). In patients with AKI, 45.0% (9/20) and 64.1% (34/53) developed CRD in the F-BEVAR and OSR groups, respectively. No new cases of dialysis were observed during follow-up in both groups . CRD was significantly higher in the OSR group (47.4% vs 27.8%; p<.01), and correlated to the post-operative AKI, age, and duration of aortic clamping (>30 min). During follow-up, 23 reinterventions (23.5%) were performed in the F-BEVAR group, and 5 (5.1%) in the OSR group (p<.01).
Conclusion:
The present study describes the long-term outcomes of a matched populations of patients with c-AAA following F-BEVAR and OSR. Similar mortality and aortic-related mortality rates were observed. The F-BEVAR group presented a higher rate of reinterventions; CRD was significantly higher in OSR group and was correlated to post-operative AKI. To achieve the best possible long-term outcome, both techniques should be performed in high volume aortic centers and tailored to the patient. A strict surveillance imaging follow-up is essential in both groups.
References:
Oderich GS, Forbes TL, Chaer R, Davies MG, Lindsay TF, Mastracci T, et al. Reporting standards for endovascular aortic repair of aneurysms involving the renal-mesenteric arteries. J Vasc Surg 2021;73:4S-52S. Tinelli G, Crea MA, de Waure C, Di Tanna GL, Becquemin JP, Sobocinski J, et al. A propensity-matched comparison of fenestrated endovascular aneurysm repair and open surgical repair of pararenal and paravisceral aortic aneurysms. J Vasc Surg 2018;68:659-668.