Fenestrated-Branched EVAR Assessed in Complex Aortic Aneurysm

March 16, 2022—The Society for Vascular Surgery (SVS) announced findings from a study assessing the incidence of intraoperative adverse events and their impact on outcomes of fenestrated-branched endovascular aneurysm repair (FB-EVAR) for the treatment of complex aortic aneurysms.

The retrospective evaluation included 600 consecutive patients receiving FB-EVAR for the treatment of complex aneurysms between 2007 and 2019 at the Mayo Clinic in Rochester, Minnesota. Gustavo Oderich, MD, is the study’s Senior Investigator.

The study was published by Emanuel R. Tenorio, MD, et al in SVS’s Journal of Vascular Surgery.

In the SVS press release, Dr. Oderich noted that studies have demonstrated superior results for EVAR of thoracoabdominal aortic aneurysms versus open repair. Dr. Oderich advised, “However, despite many technical improvements in complex endovascular repairs, the procedure remains technically demanding with significant risks. Technical failures indeed may result in disastrous complications such as loss of a kidney, bowel, or spinal ischemia.”

As summarized in the SVS press release, the investigators reported on 600 consecutive repairs performed at the Mayo Clinic between 2007 and 2019 with the following results:

• The overall 30-day mortality was 2%.
• 18% of patients (n = 105) experienced an intraoperative adverse event (IAE), defined as any intraoperative complication or technical problem requiring an additional or unplanned procedure.
• Of 122 IAEs, the most frequent events included target artery complications (55), access complication (46), and graft complications (seven).
• IAEs did not affect patient survival (odds ratio [OR], 1.0), suggesting the intraoperative rescue maneuvers were successful.
• There were more major adverse events in patients in the IAE group, mostly related to acute kidney injury, compared to those in the non-IAE group (27% versus 11%; P < .001).

Risk factors for the IAEs included female sex (OR, 2.5), presence of target artery stenosis (OR, 2.0), and Crawford Extent II aneurysm (OR, 1.9).

In the SVS press release, Dr. Oderich commented, “Data on the incidence of IAEs during FB-EVAR and its clinical sequelae has not been previously described in detail. This large single-center study showed that IAEs were present in 18% of patients who underwent this procedure, two-thirds of which required additional procedures to treat the complications.”

Dr. Oderich further noted, “Endovascular technology continues to evolve. Novel devices have added preloaded systems, lower profile fabric, and steerable catheters and sheaths to minimize procedural difficulty.”

The study also underscores the need for not only careful treatment planning, but also operators should have an armamentarium of skillsets and devices to address these IAEs, stated the SVS press release.