F-EVAR enabled successful treatment of juxtarenal aortic aneurysm with a low complication rate.

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.

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INTRODUCTION The causes and outcomes of medicolegal claims following laparoscopic cholecystectomy were evaluated. SUBJECTS AND METHODS A retrospective analysis of the experience of a consultant surgeon acting as an expert witness within the UK and Ireland (1990-2007). RESULTS A total of 151 claims were referred for an opinion. Sixty-three related to bile duct injuries and four followed major vascular injury. Bowel injury resulted in 17 claims. A postoperative biliary leak not associated with a bile duct injury was responsible for 25 claims. Other reasons for claims included spilled gallstones, port-site herniae, haemorrhage and other recognised complications associated with laparoscopic cholecystectomy. Twelve of the claims are on-going, two went to trial, 79 (52%) were settled out of court and 58 (38%) were discontinued after the claimants were advised that they were unlikely to win their case. Disclosed settlement amounts are reported. CONCLUSIONS Bile duct and major vascular injuries are almost indefensible. The delay in diagnosis and (mis)management of other recognised complications following laparoscopic cholecystectomy have also led to a significant number of successful medicolegal claims.

Wholly endovascular TAAA repair is relatively safe, but long-term follow-up is required to establish its durability.