• Ying Huang, Jill Colglazier, Bernardo C Mendes, Alberto Pochettino, Manju Kalra, Kevin L Greason, Emanuel R Tenorio, William S Harmsen, and Gustavo S Oderich.
• Department of Cardiothoracic and Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX.
• Ann. Surg. 2024 Nov 25.

ObjectiveTo compare target artery (TA) outcomes after fenestrated or branched endovascular aortic repair (FB-EVAR) versus open surgical repair (OSR) of thoracoabdominal aortic aneurysms (TAAAs).BackgroundFew studies have compared TA outcomes after endovascular incorporation and open reconstruction.MethodsAmong consecutive patients who underwent elective OSR or FB-EVAR of TAAAs (2008-2020), we reviewed those who had postoperative imaging studies evaluating TA. Data of FB-EVAR patients were obtained from a prospectively maintained institutional database. TAs included celiac, superior mesenteric, right and left renal arteries treated during TAAA repairs. Primary endpoint was TA patency (primary and secondary).ResultsThere were 131 patients (487 TAs) treated by OSR and 350 (1,300 TAs) by FB-EVAR. In the OSR group, 440 TAs (90.3%) were reconstructed by bypasses, and 47 (9.7%) by reimplantation. In the FB-EVAR group, 841 TAs (64.7%) were incorporated by fenestrations, and 459 (35.3%) by DBs. Thirty-day TA primary patency rates were not significantly different between FB-EVAR and OSR (99.4%% vs. 99.0%, P=0.36), but secondary patency rate was higher after FB-EVAR (99.8% vs. 99.0%, P=0.02). Three-year primary patency rates were 95.9% (95% confidence interval [CI], 94.7-97.2%) and 94.7% (95% CI, 92.2-97.2%), respectively; secondary patency rates were 98.5% (95% CI, 97.7-99.2%) and 94.7% (95% CI, 95.7-99.2%), respectively. There were no significant differences in late primary patency and secondary patency between groups (each P<0.05).ConclusionTarget artery primary and secondary patency rates following elective OSR or FB-EVAR were high. Endovascular repair was not associated with loss of primary patency and late secondary patency.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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