Roy, IN; Millen, AM; Jones, SM; Vallabhaneni, SR; Scurr, JRH; McWilliams, RG; Brennan, JA; Fisher, RK
(2017)
Long-term follow-up of fenestrated endovascular repair for juxtarenal aortic aneurysm.
Br J Surg, 104 (8).
pp. 1020-1027.
ISSN 1365-2168
https://doi.org/10.1002/bjs.10524
SGUL Authors: Roy, Iain Nicholas
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Abstract
BACKGROUND: Fenestrated endovascular aneurysm repair (FEVAR) is increasingly being used for juxtarenal aortic aneurysms. The aim of this study was to review long-term results and assess the importance of changing stent-graft design on outcomes. METHODS: This was a retrospective review of all patients who underwent FEVAR within a single unit over 12 years (February 2003 to December 2015). Kaplan-Meier analysis of survival, and freedom from target vessel loss, aneurysm expansion, graft-related endoleak and secondary intervention was performed. Comparison between outcomes of less complex grafts (fewer than 3 fenestrations) and more complex grafts (3 or 4 fenestrations) was undertaken. RESULTS: Some 173 patients underwent FEVAR; median age was 76 (i.q.r. 70-79) years and 90·2 per cent were men. Median aneurysm diameter was 63 (59-71) mm and median follow-up was 34 (16-50) months. The adjusted primary technical operative success rate was 95·4 per cent. The in-hospital mortality rate was 5·2 per cent; there was no known aneurysm-related death during follow-up. Median survival was 7·1 (95 per cent c.i. 5·2 to 8·1) years and overall survival was 60·1 per cent (104 of 173). There was a trend towards an increasing number of fenestrations in the graft design over time. In-hospital mortality appeared higher when more complex stent-grafts were used (8 versus 2 per cent for stent-grafts with 3-4 versus fewer than 3 fenestrations; P = 0·059). Graft-related endoleaks were more common following deployment of stent-grafts with three or four fenestrations (12 of 90 versus 6 of 83; P < 0·001). CONCLUSION: Fenestrated endovascular aneurysm repair for juxtarenal aneurysm is associated with few aneurysm-related deaths in the long term. Significant numbers of secondary interventions are required, but the majority of these can be performed using an endovascular approach.
Item Type: | Article | ||||||||
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Additional Information: | © 2017 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by/4.0/), which permits non-commercial reuse, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com | ||||||||
Keywords: | Aftercare, Aged, Aortic Aneurysm, Abdominal, Blood Vessel Prosthesis, Endovascular Procedures, Female, Humans, Intraoperative Complications, Length of Stay, Male, Operative Time, Postoperative Complications, Prosthesis Design, Retrospective Studies, Stents, Surgical Wound Dehiscence, Survival Analysis, Humans, Aortic Aneurysm, Abdominal, Intraoperative Complications, Postoperative Complications, Surgical Wound Dehiscence, Aftercare, Length of Stay, Survival Analysis, Retrospective Studies, Prosthesis Design, Blood Vessel Prosthesis, Stents, Aged, Female, Male, Endovascular Procedures, Operative Time, 11 Medical and Health Sciences, Surgery | ||||||||
SGUL Research Institute / Research Centre: | Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) | ||||||||
Journal or Publication Title: | Br J Surg | ||||||||
ISSN: | 1365-2168 | ||||||||
Language: | eng | ||||||||
Dates: |
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Publisher License: | Creative Commons: Attribution 4.0 | ||||||||
PubMed ID: | 28401533 | ||||||||
Web of Science ID: | WOS:000403158800008 | ||||||||
Go to PubMed abstract | |||||||||
URI: | https://openaccess.sgul.ac.uk/id/eprint/113009 | ||||||||
Publisher's version: | https://doi.org/10.1002/bjs.10524 |
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