WINDOWS Registry Compares EVAR Using Fenestrated and Branched Stent Grafts Versus Open Repair for Complex Aortic Aneurysms

 

August 18, 2015—Findings from the WINDOWS registry were published by Morgane Michel, MD, et al in the European Journal of Vascular and Endovascular Surgery (EJVES; 2015;50:189–196). 

The WINDOWS registry was conducted to compare 30-day outcomes and costs of fenestrated and branched stent grafts for endovascular aneurysm repair (EVAR) and open surgical repair (OSR) for the treatment of complex abdominal aortic aneurysms (AAAs) and thoracoabdominal aortic aneurysms (TAAAs). Prof. Jean-Pierre Becquemin, MD, served as principal investigator for the WINDOWS trial, which was conducted at CHU Henri Mondor in Creteil, France, and sponsored by Assistance Publique—Hôpitaux de Paris.

The WINDOWS investigators concluded that fenestrated/branched EVAR does not appear justified for patients with para/juxtarenal AAAs and infradiaphragmatic TAAAs who are fit for OSR but may be an attractive option for patients with para/juxtarenal AAAs not eligible for surgery and patients with supradiaphragmatic TAAAs. 

As summarized in EJVES, the multicenter, prospective WINDOWS registry was set up to evaluate fenestrated/branched EVAR in high-risk patients with para/juxtarenal AAAs and infradiaphragmatic and supradiaphragmatic TAAAs. A control group of patients treated by OSR was extracted from the French national hospital discharge database. 

The primary endpoint was 30-day mortality. Secondary endpoints included severe complications, length of stay, and costs. Mortality was assessed by survival analysis and uni/multivariate Cox regression analyses using pre- and postoperative characteristics. Bootstrap methods were used to estimate the cost-effectiveness of fenestrated/branched EVAR versus OSR.

The registry included 268 cases and 1,678 controls. There was no difference in 30-day mortality (6.7% vs 5.4%), but costs were higher with fenestrated/branched EVAR (€38,212 vs €16,497). After group stratification, mortality was similar with both treatments for para/juxtarenal AAAs (4.3% vs 5.8%) and supradiaphragmatic TAAAs (11.9% vs 19.7%) and higher with fenestrated/branched EVAR for infradiaphragmatic TAAA (11.9% vs 4%). Costs were higher with fenestrated/branched EVAR for para/juxtarenal AAAs (€34,425 vs €14,907) and infradiaphragmatic TAAAs (€37,927 vs €17,530) but not different for supradiaphragmatic TAAAs (€54,710 vs €44,163), reported the investigators in EJVES.

 

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