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Fenestrated Endovascular Approach Can Safely Repair Aneurysms

Key findings

  • Fenestrated Endovascular Aneurysm Repair (FEVAR) is a minimally-invasive operation that allows surgeons to repair the aorta by obtaining peripheral or femoral access while still preserving blood flow to the renal arteries
  • FEVAR, after comparing its outcomes to Open Surgical Repair (OSR) for Complex Abdominal Aortic Aneurysms (CAAA), was found to be safe
  • At 30-days post-procedure, FEVAR and OSR patients had similar rates of complication, intervention risk and survival for repair of complex abdominal aortic aneurysms
  • One-year survival rates were not different between the FEVAR and OSR groups
  • FEVAR, relative to OSR patients, had shorter hospital and intensive care unit stays but longer operative times

Concerned about reports of complications on fenestrated endovascular aneurysm repair (FEVAR), Massachusetts General Hospital researchers compared data on FEVAR and open surgical repair (OSR) for complex abdominal aortic aneurysms (CAAA) to better assess FEVAR’s risks. FEVAR is a minimally-invasive operation that allows surgeons to repair the aorta by obtaining peripheral or femoral access while still preserving blood flow to the renal arteries. After reviewing early and intermediate survival, graft complication and re-intervention outcomes, they found that FEVAR and OSR showed similar rates of peri-operative risk and survival, and that FEVAR was safe. And while FEVAR increased the likelihood of graft complications and re-intervention during follow-up, rates were not statistically significant.

The retrospective chart review published in Annals of Vascular Surgery assessed 116 patients that underwent repair of CAAA from January 2010 to September 2015 at a single, high-volume open aortic institution. The researchers reviewed demographic, comorbid condition, operative and 30-day postoperative outcomes data. Of the 116 patients, 18 (18%) underwent FEVAR with a fenestrated device, and 98 (82%) underwent OSR. The median follow-up time was 26 months. Compared to OSR patients, FEVAR patients presented with higher rates of congestive heart failure (22% vs. 5.1%), reflecting an overall sicker status.

Comparison of FEVAR vs. OSR revealed:

  • No differences in 30-day operative mortality or major complication rates
  • No difference in 1-year survival
  • Nearly one in five FEVAR patients developing graft complications during the follow-up period
  • FEVAR had shorter median length of stays in the intensive care unit (zero vs. three days) and hospital (two and a half vs. seven days)
  • FEVAR had slightly longer operative times than OSR patients (282 vs. 240 minutes)

Specifically, while the 30-day graft complication (5.6% vs. 5.1%) and unplanned re-intervention rates (11% vs. 8.2%) for the FEVAR and OSR groups were similar, differences emerged over the entire follow-up period. Graft complication and re-intervention rates were 17% vs. 8.2%, and 11% vs. 6.1% for FEVAR and OSR, respectively. The disparities existed even after adjusting for age, sex and co-morbidities, although they were not deemed statistically significant due to the relatively small number of FEVAR patients.

When re-interventions were done within the 30-day post-operative period, half were repeat endovascular procedures for FEVAR patients and half were open abdominal surgeries for OSR patients.

Notably, 22% of FEVAR patients avoided general anesthesia with their procedures performed percutaneously.

While FEVAR patients carry graft complication risk, their overall risk profile following surgery is similar to those receiving open surgery for CAAA, reflecting that FEVAR is safe.

percentage of FEVAR patients who developed late graft-related complications

percentage of FEVAR patients who avoided general anesthesia

Learn more about Mass General's Division of Vascular and Endovascular Surgery

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