BackgroundFenestrated endovascular aneurysm repair (FEVAR) is increasingly being used for juxtarenal aortic aneurysms. The aim of this study was to review long‐term results and assess the importance of changing stent‐graft design on outcomes.MethodsThis was a retrospective review of all patients who underwent FEVAR within a single unit over 12 years (February 2003 to December 2015). Kaplan–Meier analysis of survival, and freedom from target vessel loss, aneurysm expansion, graft‐related endoleak and secondary intervention was performed. Comparison between outcomes of less complex grafts (fewer than 3 fenestrations) and more complex grafts (3 or 4 fenestrations) was undertaken.ResultsSome 173 patients underwent FEVAR; median age was 76 (i.q.r. 70–79) years and 90·2 per cent were men. Median aneurysm diameter was 63 (59–71) mm and median follow‐up was 34 (16–50) months. The adjusted primary technical operative success rate was 95·4 per cent. The in‐hospital mortality rate was 5·2 per cent; there was no known aneurysm‐related death during follow‐up. Median survival was 7·1 (95 per cent c.i. 5·2 to 8·1) years and overall survival was 60·1 per cent (104 of 173). There was a trend towards an increasing number of fenestrations in the graft design over time. In‐hospital mortality appeared higher when more complex stent‐grafts were used (8 versus 2 per cent for stent‐grafts with 3–4 versus fewer than 3 fenestrations; P = 0·059). Graft‐related endoleaks were more common following deployment of stent‐grafts with three or four fenestrations (12 of 90 versus 6 of 83; P < 0·001).ConclusionFenestrated endovascular aneurysm repair for juxtarenal aneurysm is associated with few aneurysm‐related deaths in the long term. Significant numbers of secondary interventions are required, but the majority of these can be performed using an endovascular approach.

In this group of patients, f-EVAR reduced mortality and morbidity substantially compared with open repair and also reduced total hospital stay and ITU utilization.

Despite adjunctive intraoperative maneuvers, persistent type Ia endoleaks can be relatively common. Our study indicates that they may be observed in selected patients. Further research is required to investigate the natural course and management of type Ia endoleaks identified intraoperatively.

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CEUS can enhance EVAR surveillance through clarification of endoleak and target vessel patency when standard imaging modalities are not diagnostic.