Long-Term Outcomes of Fenestrated Aortic Endovascular Repair in Patients Bearing JuxtaRenal Aneurysms

Background: Fenestrated endografts have been a safe and effective solution in our institution for patients with juxtarenal abdominal aortic aneurysms (AAAs) that were not candidates for conventional repair and had suitable anatomy. The objective of our study was to evaluate the long-term outcomes of these interventions.

Methods: Between September 2005 and December 2021, this study included all the patients bearing juxtarenal aneurysm electively treated with a fenestrated endograft. We conducted a retrospective analysis of prospectively collected monocentric data. Preoperative, perioperative, and postoperative data were processed. Postoperative follow-up included at least a systematic computed tomography scan at 6, 12, 18, and 24 months then every year. Secondary procedure was defined as any additional procedure performed to treat aneurysm or endograft-related complications after index procedure. Demographic and perioperative data were analyzed descriptively. Overall survival and freedom from secondary procedures were determined using the Kaplan-Meier estimate.

Results: A total of 169 patients (92% male) were treated by fenestrated endograft with a mean 55 ± 37 months follow-up. The median aneurysm diameter was 59 mm. In 39 patients (23.1%), we performed a secondary procedure, by endovascular means in 57% of cases, mostly after the first year of follow-up (53.8%). The most frequent cause for secondary procedure was type 1b endoleak due to the evolution of aneurysmal disease of the iliac arteries (25.6%), followed by endograft limb thrombosis (20.5%), local complications related to index procedure (17.9%) and procedures performed to insure target vessel patency over time (18%). On the last CT scan of the follow-up, patients without secondary procedure were significantly more likely to present a shrinkage of the aneurysmal sac (P = 0.001), defined as a modification of the maximum diameter > 5 mm. Overall survival was not significantly different between patients that had secondary procedures compared to those that had not (80 months vs. 62 months, P = 0.3). Freedom from secondary procedures was 87% at 24 months and 63% at 60 months. Excluding secondary procedures within 30 days, freedom from secondary procedures was 76% at 50 months.

Conclusions: Fenestrated endografts constitute a sustainable therapeutic solution in the treatment of juxtarenal AAAs. The occurrence of late complications justifies a rigorous follow-up of treated patients.