Outcomes in Fenestrated and Branched Endovascular Aortic Repair Comparing Patients with Narrow Flow Lumen versus Standard Flow Lumen of the Paravisceral Aortic Segment.
Academic Article
Overview
abstract
OBJECTIVES: Fenestrated/branched endovascular aortic repair (F/BEVAR) with commercially available devices require a paravisceral segment >20 mm. We compared commercial and physician modified F/BEVAR outcomes in a narrowed flow lumen (NFL, <20 mm) to a standard flow lumen (SFL, ≥20 mm). METHODS: We conducted a retrospective review of F/BEVAR repairs between 2016-2024. Primary outcome was technical success and secondary endpoints were target vessel stability, type 1/3 endoleaks requiring reintervention, and major adverse events (MAE). RESULTS: A total of 136 patients underwent 138 repairs (75% male, 74±10 years), 35 repairs (25%) were in NFL and 103 (75%) in SFL. Median visceral segment diameter was 24 mm (IQR 19-29; 16mm, IQR 15-18 in NFL; 28mm, IQR 23-30 in SFL, p<.001). We observed 99% technical success. Mean fenestrations per repair was higher in NFL (3.1 vs 1.5, p<.001), and mean branches was higher in SFL (2.1 vs 0.7, p<.001). There were 24 (17%; 2 in NFL, 22 in SFL, p=.035) MAEs. There were nine branch vessel occlusions (three in NFL, six in SFL, p=.463) at a median follow up of 516 days. Target vessel stability (86% in NFL vs 84% in SFL, p=.757) and rate of reinterventions (2, 6% in NFL, 14, 14% in SFL, p=.209) did not differ significantly. CONCLUSIONS: Custom F/BEVAR offers equivalent outcomes in complex anatomy with narrowed paravisceral flow lumens compared to on-label branched and fenestrated repairs in standard flow lumens. Early results demonstrate reasonable target vessel stability and freedom from reintervention, though additional follow up is needed.
