Taher Fadi, Plimon Markus, Walter Corinna, Weiss Gabriel, Kliewer Miriam, Assadian Afshin, Falkensammer Juergen
Department of Vascular and Endovascular Surgery, Klinik Ottakring, Vienna, Austria.
Department of Cardiovascular Surgery, Klinik Floridsdorf, Vienna, Austria.
J Endovasc Ther. 2025 Feb;32(1):233-241. doi: 10.1177/15266028231174113. Epub 2023 May 8.
Fenestrated endovascular aortic repair (FEVAR) is technically more challenging when performed after a failing EVAR procedure (FEVAR after EVAR). This study aims to assess the technical outcome of FEVAR after EVAR and to identify factors that may influence complication rates.
A retrospective observational study was conducted at a single department of vascular and endovascular surgery. The rate of FEVAR after EVAR compared to primary FEVAR is reported. Complication and primary unconnected fenestration (PUF) rates as well as survival were assessed for the FEVAR after EVAR cohort. PUF rates and operating time were also compared to all primary FEVAR patients. Patient characteristics and technical factors such as number of fenestrations or use of a steerable sheath were assessed as possible influencers on technical success when performing FEVAR after EVAR.
Two hundred and nine fenestrated devices were implanted during the study period (2013 to April 2020). Thirty-five patients (16.7% of all FEVAR patients) had undergone FEVAR after EVAR and were included in the study. Overall survival at last follow-up (20.2±19.1 months) was 82.9% in FEVAR after EVAR patients. Rates of technical failure dropped significantly after 14 procedures (42.9% vs. 9.5%; p=0.03). Primary unconnected fenestrations were seen in 3 cases of FEVAR after EVAR (8.6%) and 14 of 174 primary FEVAR cases (8.0%; p>0.99). Operating time for FEVAR after EVAR was significantly higher than for primary FEVAR (301.1±110.5 minutes vs. 253.9±103.4 minutes; p=0.02). The availability of a steerable sheath was a significant predictor of reduced risk of PUFs, whereas age and gender, number of fenestrations or suprarenal fixation of the failed EVAR did not significantly influence PUF rates.
Fewer technical complications were seen over the study period in FEVAR after EVAR patients. While rates of PUFs were not different from primary FEVAR, operating time was significantly longer in patients undergoing FEVAR for failed EVAR. Fenestrated EVAR can be a valuable and safe tool to treat patients with progression of aortic disease or type Ia endoleak after EVAR but may be more complex to achieve than primary FEVAR.
This retrospective study assesses the technical outcome of fenestrated endovascular aortic repair (fenestrated EVAR; FEVAR) after prior EVAR. While rates of primary unconnected fenestrations were not different from primary FEVAR, operating time was significantly longer in patients undergoing FEVAR for failed EVAR. Fenestrated EVAR after prior EVAR may be technically more challenging than primary FEVAR procedures, but could be performed with equally good results in this patient cohort. FEVAR offers a feasible treatment option for patients with progression of aortic disease or type Ia endoleak after EVAR.
在腔内血管修复术（EVAR）失败后进行开窗型腔内主动脉修复术（FEVAR）在技术上更具挑战性（EVAR术后FEVAR）。本研究旨在评估EVAR术后FEVAR的技术结果，并确定可能影响并发症发生率的因素。
在一个血管和腔内血管外科单一科室进行了一项回顾性观察研究。报告了EVAR术后FEVAR与初次FEVAR的比率。评估了EVAR术后FEVAR队列的并发症、原发性未连接开窗（PUF）率以及生存率。还将PUF率和手术时间与所有初次FEVAR患者进行了比较。评估了患者特征和技术因素，如开窗数量或使用可操纵鞘管，作为在EVAR术后进行FEVAR时影响技术成功的可能因素。
在研究期间（2013年至2020年4月）植入了209个开窗装置。35例患者（占所有FEVAR患者的16.7%）在EVAR术后接受了FEVAR，并纳入研究。EVAR术后FEVAR患者在最后一次随访时（20.2±19.1个月）的总生存率为82.9%。14例手术后技术失败率显著下降（42.9%对9.5%；p = 0.03）。EVAR术后FEVAR有3例（8.6%）出现原发性未连接开窗，174例初次FEVAR中有14例（8.0%）出现原发性未连接开窗（p>0.99）。EVAR术后FEVAR的手术时间显著长于初次FEVAR（301.1±110.5分钟对253.9±103.4分钟；p = 0.02）。可操纵鞘管的可用性是降低PUF风险的重要预测因素，而年龄、性别、开窗数量或失败的EVAR的肾上固定对PUF率没有显著影响。
在研究期间，EVAR术后FEVAR患者出现的技术并发症较少。虽然PUF率与初次FEVAR没有差异，但因EVAR失败而接受FEVAR的患者手术时间明显更长。开窗型EVAR可以是治疗主动脉疾病进展或EVAR术后Ia型内漏患者的一种有价值且安全的工具，但可能比初次FEVAR更复杂。
这项回顾性研究评估了先前EVAR后开窗型腔内主动脉修复术（开窗型EVAR；FEVAR）的技术结果。虽然原发性未连接开窗率与初次FEVAR没有差异，但因EVAR失败而接受FEVAR的患者手术时间明显更长。先前EVAR后的开窗型EVAR在技术上可能比初次FEVAR手术更具挑战性，但在该患者队列中可以取得同样好的结果。FEVAR为EVAR术后主动脉疾病进展或Ia型内漏患者提供了一种可行的治疗选择。
