• Andrés Reyes, Konstantinos P Donas, Georgios Pitoulias, Martin Austermann, Claudio Gandarias, and Giovanni Torsello.
• Department of Vascular and Endovascular Surgery, Ramón y Cajal's University Hospital, Madrid, Spain cauzaza@hotmail.com.
• J. Endovasc. Ther. 2016 Aug 1; 23 (4): 599-605.

PurposeTo evaluate the totally endovascular techniques for treating complex pararenal aortic aneurysms after open repair of abdominal aortic aneurysm.MethodsThis retrospective study involved 34 men (mean age 74 years) with pararenal aortic aneurysms (22 pseudoaneurysms and 12 para-anastomotic aneurysms) that developed a median 11 years (range 4-22) after the primary surgical reconstruction. The median infrarenal neck length was 2 mm (range 0-9). Total endovascular aneurysm repair (EVAR) included the use of fenestrated (f-EVAR; n=17), branched (b-EVAR; n=11), combined f-EVAR/b-EVAR (n=1), and chimney (ch-EVAR; n=4) grafts and the "sandwich" technique (n=1). The primary outcome was aneurysm shrinkage >5 mm at latest follow-up. Secondary outcomes were target vessel patency, 30-day mortality, late survival, absence of type I and III endoleak, clinical success, and reintervention rate.ResultsTechnical success was 97% (n=33/34), while clinical success was achieved in 32 (94%) patients. The 30-day mortality was 3% (n=1/34). Mean follow-up was 23.2±16.6 months. One patient was lost to follow-up, and 1 patient underwent late open conversion for endograft infection. Six (18%) of the 33 surviving patients required a reintervention. Primary patency of the target aortic branches was 98% (109/111). Mean aneurysm diameter decreased from 64.1±10.2 to 56.7±16.9 mm (p<0.001) at latest follow-up. Midterm mortality was 12.1% (4/33). Estimated survival rates at 1 and 2 years were 93.9% and 90.9, respectively.ConclusionUse of f-EVAR, b-EVAR, and ch-EVAR allows effective treatment of postsurgical pararenal aneurysms based on a clear algorithm and patient selection, highlighting the complementary character of these less invasive approaches.© The Author(s) 2016.

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