Key result
F-BEVAR for failed pEVAR compared to pOAR showed similar technical success (93.4% vs 92.2%, P=0.58) but lower 5-year freedom from reintervention (38.3% vs 56.0%, P=0.004).
Why the study?
Treatment of failed previous abdominal aortic aneurysm repair is complex, and comparative data on F-BEVAR outcomes, risk factors, and indications remain limited.
Does F-BEVAR have different outcomes when performed for failed pEVAR compared to failed pOAR in patients with previous infrarenal aortic repair?
Cohort (n=526)
Yes
Does F-BEVAR have different outcomes when performed for failed pEVAR compared to failed pOAR in patients with previous infrarenal aortic repair?
Absolute Event Rate: 93.4% vs 92.2%
p-value: p=0.58
F-BEVAR is a safe and feasible treatment for failed previous aortic repairs, though patients with prior EVAR have significantly higher rates of reintervention at 5 years compared to those with prior open repair.
Comparable early outcomes support F-BEVAR feasibility after failed repairs; lower reintervention freedom after pEVAR leaves open durability questions.
OBJECTIVE: 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 to 2021 from 17 European vascular centers were analyzed. Endpoints included technical success, major adverse events, 30-day mortality, and 5-year estimates of survival, target vessel primary patency, freedom from reinterventions, type I/III endoleaks, and sac growth >5 mm. BACKGROUND: Treatment of a failed previous abdominal aortic aneurysm repair is a complex undertaking. F-BEVAR is becoming an increasingly attractive option, although comparative data are limited regarding associated risk factors, indications for treatment, and various outcomes. RESULTS: There were 526 patients included, 268 pOAR and 258 pEVAR. The median time from previous repair to F-BEVAR was 7 (interquartile range, 4-12) years, 5 (3-8) for pEVAR, and 10 (6-14) for pOAR, P <0.001. Predominant indication for treatment was type Ia endoleak for pEVAR and progression of the disease for pOAR. Technical success was 92.8%, pOAR (92.2%), and pEVAR (93.4%), P =0.58. The 30-day mortality was 6.5% overall, 6.7% for pOAR, and 6.2% for pEVAR, P =0.81. There were 1853 treated target vessels with 5-year estimates of primary patency of 94.4%, pEVAR (95.2%), and pOAR (94.4%), P =0.03. Five-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 =0.004. The most common indication for reinterventions was for type I/III endoleaks (37.5%). CONCLUSIONS: Repair of a failed pEVAR or pOARis 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 target vessels/bridging stents.
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Budtz-Lilly et al. (2022) conducted a cohort in Failed previous endovascular or open abdominal aortic aneurysm repair (n=526). F-BEVAR for failed pEVAR vs. F-BEVAR for failed pOAR was evaluated on Technical success (p=0.58). F-BEVAR for failed pEVAR compared to pOAR showed similar technical success (93.4% vs 92.2%, P=0.58) but lower 5-year freedom from reintervention (38.3% vs 56.0%, P=0.004).
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