Mid-term proximal sealing zone evaluation after fenestrated endovascular aortic aneurysm repair

Abstract

BaCKground: fenestrated endovascular aortic aneurysm repair (fevar) is used in pararenal abdominal aortic aneurysms to achieve a durable proximal seal. This study investigated the mid-term course of the proximal fenestrated stent graft (FSG) sealing zone on the first and latest available post-fevar computed tomographic angiography (CTa) scan in a single-center series. MeThods: in 61 elective fevar patients, the shortest length of circumferential apposition between the fsg and the aortic wall (shortest apposition length [SAL]) was retrospectively assessed on the first and last available postoperative CTA scans. Patient records were reviewed for fevar-related procedural details, complications, and reinterventions. RESULTS: The median (interquartile range) time between the FEVAR procedure and the first and last CTA scan was 35 (30-48) days and 2.6 (1.2-4.3) years, respectively. The median (interquartile range) SAL was 38 (29-48) mm, and 44 (34-59) mm on the first and last CTA scans, respectively. During follow-up, the SAL increased >5 mm in 32 patients (52%), and decreased >5 mm in six patients (10%). Reintervention was performed for a type 1a endoleak in one patient. Twelve other patients needed 17 reinterventions for other fevar-related complications. ConClusions: good mid-term apposition of the fsg in the pararenal aorta was achieved post-fevar, and the occurrence of type 1a endoleaks was low. The number of reinterventions was substantial, however, but for reasons other than loss of proximal seal.

Sealing zone issues in different parts of the aorta post-endovascular repair

“…14 extension of the seal zone in the non-diseased juxta-and suprarenal aorta is expected to lead to a sustainable seal. van der riet et al 15 determine the achieved apposition length in 61 feVar patients on the first postoperative CT scan and show how the apposition will change at midterm follow-up.…”