Long-term Target Vessel Occlusion Outcomes After Fenestrated/Branched Endovascular Aortic Repair

The aim of this study was to analyze the 5-year incidence of target vessel occlusion (TVO) in fenestrated/branched endovascular aneurysm repair (F/BEVAR) cases, evaluating management, outcomes, and potential effects on long-term survival. A single-center, retrospective analysis was performed, including patients with the diagnosis of complex aortic aneurysms who underwent a F/BEVAR procedure. The occlusion of any of the target visceral arteries, either incorporated in the repair by a branch or fenestration, was included in this study if the vessel was stented during the index procedure. Patients who presented TVO were compared with the ones who did not have this adverse event with respect to demographics, aneurysm extension, aneurysm sac size, and 5-year risk of death. Four hundred and thirty-three F/BEVAR cases performed between July 2012 and May 2023 incorporating 1648 TV were included in the study (mean age, 72 ± 7.9 years; 72.2% males), with 20 individuals (4.6%; mean age, 68 ± 5.7 years; 72.2% males) subsequently presenting with occlusion of 24 target vessels(12 renal, 1 accessory renal, 1 hepatic, 6 celiac, and 4 superior mesenteric arteries [SMA]; occlusion rate, 1.45%). In terms of demographics, aneurysm extent (P = .155), or aneurysm maximum diameter (P = .140), there was no significant difference between the patients with and without TVO. Twenty of the occluded TVs (83.3%) were incorporated into the repair by fenestrations, and four (16.6%) by using branches. Balloon-expandable stents were used in 22 (91.6%) occluded vessels. Only 20.8% of the occluded TVs presented significant stenosis prior to the F/BEVAR procedure. Among the TVO cases, 85% were taking aspirin, 30% clopidogrel, and 5% were taking oral anticoagulants at the time of the occlusion event. Only 20% of the patients with TVOs were active smokers when the adverse event happened. The mean time-to-occlusion was 16.7 ± 16.5 months. Nine patients underwent a TVO-related secondary intervention (mostly percutaneous) involving 12 target vessels, and flow was reestablished in 58% of the arteries. The celiac artery occlusions were managed conservatively in all cases when patent SMA vessels were present. There was one TVO-related death secondary to mesenteric ischemia complications. The 5-year risk of death was not significantly different when patients that presented TVO were compared with the ones without this adverse event (P = .304). TVO is a rare adverse event after F/BEVAR, potentially occurring even in patients on antiplatelet therapy who are not active smokers. TVO-related secondary interventions have a relatively low rate of success. The conservative management of celiac artery occlusions appears to be tolerated in patients with patent SMA vessels. The occurrence of a TVO does not impact the 5-year mortality in F/BEVAR cases, possibly due to the infrequency of this adverse event.