A nonsystematic review of the early, mid-term, and long-term outcomes for fenestrated and branched endovascular repair of thoracoabdominal aneurysms

Background

Over the last two decades, the development of fenestrated and branched aortic endografts (F/BEVAR) has enabled endovascular repair of thoracoabdominal aortic aneurysms (TAAAs) in high surgical risk patients. F/BEVAR has demonstrated acceptable early and mid-term outcomes; however, challenges include bridging stent instability and a high rate of reinterventions. Evaluating the long-term outcomes and durability of F/BEVAR is important for broader application of this technology.

Methods

We conducted a comprehensive, nonsystematic review of the literature reporting on the early, mid-term, and earl-long term outcomes for branched and fenestrated endovascular repair of TAAAs. The authors achieved consensus on the studies reviewed. Studies were evaluated based on the type and extent of aneurysms treated, long-term mortality, reintervention, and branch graft instability, although no pooled data analysis was performed.

Results

Retrospective cohort studies have reported a short-term mortality benefit for F/BEVAR in anatomically suitable high surgical risk patients. In the studies reviewed, the overall survival rate after FEVAR ranged from 81% to 100% at 1 year, 32% to 76% at 5 years, and 33% to 52% at 7 years. Freedom from reintervention after FEVAR ranged from 38% to 91% at 3 years and 50%% to 80% at 5 years. Bridging stent graft instability resulting in endoleak remain a significant clinical challenge and a primary driver of reintervention. Reports of target vessel patency ranged 89% to 96% at 3 years, and 86% to 99% at 5 years.

Conclusions

TAAAs present a challenging pathology associated with significant morbidity and mortality after surgical repair. Fenestrated and branched endovascular repair has enabled minimally invasive repair in high surgical risk patients and has demonstrated acceptable short- and mid-term outcomes including an early survival benefit, and a low rate of aortic-related mortality. F/BEVAR has also been associated with a higher rate of long-term reinterventions. Main body endoleak from progressive degeneration and branch graft instability have emerged as the primary drivers of long-term reinterventions.