O-226 - EUROPEAN MULTICENTRIC EXPERIENCE WITH FENESTRATED-BRANCHED ENDOVASCULAR STENT-GRAFTING AFTER PREVIOUS FAILED INFRARENAL AORTIC REPAIR

TOPIC:
Thoraco-abdominal Aortic Disease
AUTHORS:
Budtz-Lilly J. (Aarhus University Hospital ~ Aarhus ~ Denmark) , D'Oria M. (University Hospital of Trieste ASUGI ~ Trieste ~ Italy) , Mees B. (Maastricht Heart and Vascular Center ~ Maastricht ~ Netherlands) , Gargiulo M. (DIMES-University of Bologna, IRCCS-University Hospital Policlinico S. Orsola ~ Bologna ~ Italy) , Unosson J. (University of Uppsala ~ Uppsala ~ Sweden)
Introduction:
To report the mid-term outcomes of fenestrated-branched endovascular aneurysm repair (F-BEVAR) following a failed previous endovascular aneurysm repair (pEVAR) or previous open aneurysm repair (pOAR).
Methods:
Data from consecutive patients who underwent F-BEVAR for pEVAR or pOAR from 2006-2021 from 17 European vascular centres were analyzed. The endpoints were technical success, major adverse events (MAE), 30-day mortality, and 5-year estimates of survival, target vessel primary patency, freedom from reinterventions, type I/III endoleaks, and sac growth > 5mm, using Kaplan-Meier estimates and a competing risk model. Cox proportional hazard modelling was used for multivariable analysis.
Results:
There were 526 patients included, 268 pOAR and 258 pEVAR; mean age was 75.0 ± 6.9 for pEVAR, 72.7 ± 6.3 for pOAR, p < .001. Median time from previous repair to F-BEVAR was 7 (IQR, 4-12) years, 5 (3-8) for pEVAR and 10 (6-14) for pOAR, p<.001. Median aneurysm diameter was 70 (60-83) mm for pEVAR vs 65 (56-71) mm for pOAR (p <.001). Predominant indication for treatment was Type Ia endoleak for pEVAR and progression of disease for pOAR. Overall technical success was 92.8%, pOAR (92.2%) and pEVAR (93.4%), p=.58. The 30-day mortality was 6.5% overall, 6.7% for pOAR and 6.2% for pEVAR, p=.81. Rates of MAE were similar, including any spinal cord ischemia. Five-year estimates of survival (overall, 55.5%) were similar: 52.2% for pEVAR and 57.5% for pOAR, p=.90. There were 1853 treated target vessels with 5-year estimates of primary patency of 94.4%, pEVAR (95.2%) and pOAR (94.4%), p=.03. While 5-year estimates for freedom from type I/III endoleaks were similar between groups, freedom from reintervention was lower for pEVAR (38.3%) than for pOAR (56.0%), p=.004 The most common indication for reinterventions was for type I/III endoleaks (37.5%) Five-year freedom from sac growth was 44.7% for pEVAR and 78.0% for pOAR, p<.001.
Conclusion:
The repair of a failed previous EVAR or OAR is safe and feasible with comparable technical success and survival rates. While successful treatment can be achieved, significant rates of reintervention should be anticipated, particularly for issues related to instability of the target vessels/bridging stents.