Long-term outcomes of complex FEVAR at a single aortic centre during 10 years

Abstract Introduction Endovascular repair with fenestrated and/or branched endografts (f/bEVAR) is an established treatment for complex abdominal aortic aneurysms (AAA) (Wanhainen et al, EJVES 2024). We have previously shown good long-term outcomes in an earlier cohort with a mean of 2.1 fenestrations/case (Sveinsson et al, JVS 2021). This study aims to evaluate the long-term clinical outcomes of FEVAR when repairs were routinely more extensive. Method All patients undergoing elective FEVAR between 2013-2022 were included and data was retrospectively collected from medical records. Primary outcomes were overall survival and freedom from aneurysm related death. Secondary outcomes were clinical success, patency of target vessels and freedom of re-interventions. Result 238 patients were included and 215 (90.4%) patients received ≥3 fenestrations with a mean of 3.4 fenestrations per case. Technical success was obtained in 216 (90.8%) of the cases, while 30-day mortality was 1.7%. During a follow-up of 50±33 months the estimated overall survival and the estimated freedom from aneurysm-related mortality at 5 years were 63±4% and 95±1%, respectively. Primary patency on patient level was 81±3% at 5 years, increasing to 89±2% with the help of reinterventions that were necessary in 77 patients. Discussion FEVAR continues to provide good long-term protection from aneurysm-related mortality. The majority of the patients maintained target vessel patency, though the need for reinterventions is not obliviated. The results are identical to our previous ones, despite the increased anatomical complexity of the repairs, which may be a reflection of the routine use of intraoperative adjunctive measures such as fusion imaging and CBCT.