Annals of vascular surgery · 2026
Mid- to Long-Term Outcomes of an Early Experience with Fenestrated Endovascular Aortic Repair for Pararenal Versus Juxtarenal and Infrarenal Aneurysms.
СтатьяНазвание и аннотация: Перевод в очереди
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Basu Rohan, Davis Joshua, Hughes Alexa, Sawchuk Alan, Motaganahalli Raghu, Fajardo Andres
Аннотация
BACKGROUND: The Zenith Fenestrated (ZFEN) platform is commercially available in the United States for fenestrated endovascular aortic repair (FEVAR) in infrarenal abdominal aortic aneurysms (AAAs) with neck lengths of ≥4 mm. However, ZFEN has been used outside manufacturer instructions for the use of AAA with shorter necks or more proximal extents. Long-term data characterizing ZFEN results in these real-world applications are limited. We describe the mid- to long-term outcomes of our early experience using ZFEN for FEVAR in the pararenal segment.
METHODS: We reviewed all ZFEN repairs performed between April 2012 and April 2017 at an academic referral center. Cases done using modified grafts or for EVAR salvage were excluded. Results up to 8 years of follow-up using ZFEN were compared between FEVAR for pararenal AAA versus juxta/infrarenal AAA. Primary outcomes included freedom from reintervention and overall survival.
RESULTS: There were 90 cases included (26 pararenal, 64 juxta/infrarenal). At 8 years, estimated freedom from reintervention was 67.4% versus 57.6% (P = 0.93), while overall survival was 35.9% versus 42.3% (P = 0.46) in the pararenal and juxta/infrarenal groups, respectively. In the series overall, 25 patients (27.8%) required reintervention, with seven (26.9%) in the pararenal group versus 18 in the juxta/infrarenal group (28.1%). Reinterventions were most often performed for endoleaks.
CONCLUSION: Pararenal FEVAR using the ZFEN platform demonstrated no statistically significant differences in freedom from reintervention or overall survival compared to juxta/infrarenal FEVAR. However, the study is underpowered to prove true equivalence due to sample size and low event rates. Reintervention rates remain high, primarily due to endoleaks within the first 2-3 years. While few aneurysm-related deaths were observed, long-term outcomes remain uncertain due to substantial loss to follow-up. Consequently, late endoleaks, ruptures, and reinterventions may be underestimated. These data suggest that pararenal ZFEN outcomes do not statistically differ from juxta/infrarenal outcomes, though uncertainty remains, requiring ongoing long-term surveillance.
METHODS: We reviewed all ZFEN repairs performed between April 2012 and April 2017 at an academic referral center. Cases done using modified grafts or for EVAR salvage were excluded. Results up to 8 years of follow-up using ZFEN were compared between FEVAR for pararenal AAA versus juxta/infrarenal AAA. Primary outcomes included freedom from reintervention and overall survival.
RESULTS: There were 90 cases included (26 pararenal, 64 juxta/infrarenal). At 8 years, estimated freedom from reintervention was 67.4% versus 57.6% (P = 0.93), while overall survival was 35.9% versus 42.3% (P = 0.46) in the pararenal and juxta/infrarenal groups, respectively. In the series overall, 25 patients (27.8%) required reintervention, with seven (26.9%) in the pararenal group versus 18 in the juxta/infrarenal group (28.1%). Reinterventions were most often performed for endoleaks.
CONCLUSION: Pararenal FEVAR using the ZFEN platform demonstrated no statistically significant differences in freedom from reintervention or overall survival compared to juxta/infrarenal FEVAR. However, the study is underpowered to prove true equivalence due to sample size and low event rates. Reintervention rates remain high, primarily due to endoleaks within the first 2-3 years. While few aneurysm-related deaths were observed, long-term outcomes remain uncertain due to substantial loss to follow-up. Consequently, late endoleaks, ruptures, and reinterventions may be underestimated. These data suggest that pararenal ZFEN outcomes do not statistically differ from juxta/infrarenal outcomes, though uncertainty remains, requiring ongoing long-term surveillance.