• Jacob Budtz-Lilly, Mario D'Oria, Enrico Gallitto, Luca Bertoglio, Tilo Kölbel, David Lindström, Nuno Dias, Goran Lundberg, Dittmar Böckler, Gianbattista Parlani, Michele Antonello, Gian F Veraldi, Nikolaos Tsilimparis, Drosos Kotelis, Philip Dueppers, Giovanni Tinelli, Arnaldo Ippoliti, Paolo Spath, Antonino Logiacco, SchurinkGeert Willem HGWHDivision of Vascular Surgery, Maastricht Heart and Vascular Center, Maastricht, The Netherlands., Roberto Chiesa, Alessandro Grandi, Giuseppe Panuccio, Fiona Rohlffs, Anders Wanhainen, Kevin Mani, Angelos Karelis, Björn Sonesson, Magnus Jonsson, Alina-Marilena Bresler, Gioele Simonte, Giacomo Isernia, Andrea Xodo, Luca Mezzetto, Davide Mastrorilli, Carlota F Prendes, Basel Chaikhouni, Alexander Zimmermann, Sandro Lepidi, Mauro Gargiulo, Barend Mees, and Jon Unosson.
• Section of Vascular Surgery, Department of Surgical Sciences, University of Uppsala, Uppsala, Sweden.
• Ann. Surg. 2023 Aug 1; 278 (2): e389e395e389-e395.

ObjectiveTo report the mid-term outcomes of fenestrated-branched endovascular aneurysm repair (F-BEVAR) following a failed previous endovascular aneurysm repair (pEVAR) or previous open aneurysm repair (pOAR).MethodsData from consecutive patients who underwent F-BEVAR for pEVAR or pOAR from 2006 to 2021 from 17 European vascular centers were analyzed. Endpoints included technical success, major adverse events, 30-day mortality, and 5-year estimates of survival, target vessel primary patency, freedom from reinterventions, type I/III endoleaks, and sac growth >5 mm.BackgroundTreatment of a failed previous abdominal aortic aneurysm repair is a complex undertaking. F-BEVAR is becoming an increasingly attractive option, although comparative data are limited regarding associated risk factors, indications for treatment, and various outcomes.ResultsThere were 526 patients included, 268 pOAR and 258 pEVAR. The median time from previous repair to F-BEVAR was 7 (interquartile range, 4-12) years, 5 (3-8) for pEVAR, and 10 (6-14) for pOAR, P <0.001. Predominant indication for treatment was type Ia endoleak for pEVAR and progression of the disease for pOAR. Technical success was 92.8%, pOAR (92.2%), and pEVAR (93.4%), P =0.58. The 30-day mortality was 6.5% overall, 6.7% for pOAR, and 6.2% for pEVAR, P =0.81. There were 1853 treated target vessels with 5-year estimates of primary patency of 94.4%, pEVAR (95.2%), and pOAR (94.4%), P =0.03. Five-year estimates for freedom from type I/III endoleaks were similar between groups; freedom from reintervention was lower for pEVAR (38.3%) than for pOAR (56.0%), P =0.004. The most common indication for reinterventions was for type I/III endoleaks (37.5%).ConclusionsRepair of a failed pEVAR or pOARis safe and feasible with comparable technical success and survival rates. While successful treatment can be achieved, significant rates of reintervention should be anticipated, particularly for issues related to instability of target vessels/bridging stents.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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