Fenestrated/branched endovascular aortic repair after failed endovascular aortic repair has similar perioperative outcomes to primary repairs.

OBJECTIVE

To evaluate the outcomes of fenestrated-branched endovascular aneurysm repair (FB-EVAR) in patients undergoing reintervention for failed EVAR compared with those undergoing primary FB-EVAR.

METHODS

Patients undergoing FB-EVAR between 2014 and 2024 were identified in the Vascular Quality Initiative database. Patients were then divided into two groups, those undergoing FB-EVAR after failed EVAR and those undergoing primary FB-EVAR. Baseline characteristics, operative details, and outcomes were compared between groups. Primary outcomes included mortality, reintervention, and endoleak (EL) (type I/III) rates. Secondary outcomes included perioperative complications. Kaplan-Meier survival analysis and Cox regression were used to evaluate 1-year outcomes.

RESULTS

A total of 2067 patients were included in this study; 386 (18.6%) underwent FB-EVAR after failed EVAR, and 1681 (81.4%) underwent primary FB-EVAR. In the failed EVAR group, perioperative mortality (3.1% vs 4%; P = .934) and rates of type I/III endoleaks (6.5% vs 8.6%; P = .164) were comparable with that of no prior EVAR. At the 12-month follow-up, mortality rates remained similar (17.2% vs 15.8%; P = .265), However, patients with prior EVAR had a significantly higher reintervention rates (hazard ratio, 1.60; 95% confidence interval, 1.10-2.35; P = .015), despite similar mortality and EL rates.

CONCLUSIONS

FB-EVAR is a safe and effective reintervention strategy after failed EVAR, achieving similar mortality and EL outcomes compared with primary FB-EVAR. However, the significantly higher reintervention rates in patients with prior EVAR may be related to the increased complexity this population.