• Annals of surgery · Jan 2015

    Multicenter Study Clinical Trial

    Results and factors affecting early outcome of fenestrated and/or branched stent grafts for aortic aneurysms: a multicenter prospective study.

    • J Marzelle, E Presles, J P Becquemin, and WINDOWS trial participants.
    • *Department of Vascular Surgery, Hospital Henri Mondor, University Paris XII, Creteil, France †Unité de Recherche Clinique, Innovation et Pharmacologie, CHU Saint Etienne, France, and INSERM, CIE3, F-42055 Saint Etienne, France.
    • Ann. Surg.. 2015 Jan 1;261(1):197-206.

    ObjectiveTo present results and to identify predictive factors of early outcome after fenestrated and/or branched endovascular repair (f/b-EVAR) for complex aortic aneurysms, abdominal (AAA) and thoracoabdominal (TAAA).BackgroundFeasibility of f/b-EVAR for complex aneurysms is now established, but little is known about which patients will benefit from this technique.MethodsUnivariate and multivariate analysis of preoperative and intraoperative factors on postoperative mortality and complications was performed on 268 patients (group 1: juxta- and pararenal AAA; group 2: suprarenal and TAAA IV; group 3: TAAA I, II, III) enrolled in a prospective multicenter trial of f/b-EVAR.ResultsThirty-day mortality, in-hospital mortality (IM), and combined mortality and severe complications (CMSC) rates were 6.7%, 10.1%, and 22.0%, respectively. Group belonging (2 or 3 vs 1) was the only preoperative predictive factor of CMSC [hazard ratio (HR) = 2.10; 95% confidence interval (CI): 1.26-3.48; P = 0.0043]. Occurrence of a technical complication and duration of intervention significantly influenced both IM (HR = 4.39; 95% CI: 2.05-9.38; P = 0.0001) and CMSC (HR = 3.07; 95% CI: 1.84-5.11; P < 0.0001). Postoperative events associated with increased IM were spinal cord ischemia (HR = 9.46; 95% CI: 3.98-22.47; P < 0.0001), hemodialysis (HR = 27.44; 95% CI: 12.63-59.61; P < 0.0001), and reintervention (HR = 4.45; 95% CI: 2.03-9.73; P = 0.0002).ConclusionsAlthough promising, f/b-EVAR still carries a significant rate of mortality and complications, mostly related to the complexity of the procedure. In these complex cases, new strategies should be investigated to improve outcomes.

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