Key result
fEVAR links to ~60% lower perioperative morbidity than OSR with similar mortality.
Why the study?
Outcomes needed to be compared between patients treated for pararenal aortic aneurysms using fenestrated endovascular aneurysm repair versus open surgical repair across high-volume centers.
Does fenestrated endovascular aneurysm repair compared to open surgical repair improve outcomes in patients with pararenal abdominal aortic aneurysms?
Cohort (n=200)
Yes
Does fenestrated endovascular aneurysm repair compared to open surgical repair improve outcomes in patients with pararenal abdominal aortic aneurysms?
Odds Ratio: 2.5 (95% CI 1.09–5.71)
p-value: p=0.033
fEVAR and OSR provide similar early and midterm survival for pararenal aortic aneurysms, but involve a trade-off between higher perioperative systemic complications with OSR and higher late reintervention needs with fEVAR.
fEVAR may lower perioperative morbidity versus OSR without mortality difference; leaves open randomized trials before practice change.
PURPOSE: To compare outcomes of patients treated for pararenal aortic aneurysms using fenestrated endovascular aneurysm repair (fEVAR) vs open surgical repair (OSR) in 3 high-volume centers. MATERIALS AND METHODS: A multicenter retrospective analysis was conducted of 200 pararenal abdominal aortic aneurysm patients electively treated with OSR (n=108) or fEVAR (n=92) from 1998 to 2015 at 3 tertiary institutions. Endpoints were 30-day morbidity and mortality, late reinterventions, visceral artery occlusion, and mortality. Analysis was conducted on the entire population and on a propensity score-matched population constructed on age, gender, coronary artery disease (CAD), and chronic renal failure. RESULTS: In the total cohort, fEVAR patients were significantly (p<0.001) older and had higher frequencies of CAD (p<0.001) and previous stroke (p=0.003). OSR patients had higher risk of perioperative morbidity (OR 2.5, 95% CI 1.09 to 5.71, p=0.033), specifically respiratory failure (OR 4.06, 95% CI 1.12 to 4.72, p=0.034). These findings were confirmed in the propensity-adjusted analysis, where cardiac complications were also higher after OSR (OR 12.8, 95% CI 0.07 to 0.21, p=0.02). No difference in perioperative mortality (2.2% in fEVAR vs 1.9% in OSR) was identified. Mean follow-up was 50 months (range 0-119). Four-year results showed higher survival (91.2% vs 69.3%, p=0.02) and freedom from reintervention (95.6% vs 77.8%, p=0.01) after OSR in the unmatched population, with a small but significant (p=0.021) difference in the risk of late visceral artery occlusion/stenosis after fEVAR. On propensity analysis, no differences in late survival were found between groups. CONCLUSION: fEVAR and OSR may afford similar early and midterm survival rates. Higher risks of perioperative systemic complications after OSR are counterbalanced by higher risks of late visceral vessel patency issues and need for reintervention after fEVAR. Both procedures are safe and effective in the long term in experienced centers, where patient evaluation should drive the treatment strategy.
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Fiorucci et al. (2018) conducted a cohort in Pararenal aortic aneurysms (n=200). Fenestrated endovascular aneurysm repair (fEVAR) vs. Open surgical repair (OSR) was evaluated on Perioperative morbidity (OR 2.5, 95% CI 1.09-5.71, p=0.033). Fenestrated EVAR for pararenal aortic aneurysms had similar perioperative mortality to open surgical repair (2.2% vs 1.9%) but was associated with lower perioperative morbidity (OSR OR 2.5; P=0.033).