Unlabelled: This retrospective observational study using clinical data from two large hospitals in the Netherlands evaluated midterm outcomes of fenestrated endovascular aortic repair for juxtarenal abdominal aortic aneurysms (JAAAs), comparing supracoeliac with infracoeliac sealing. Supracoeliac sealing is considered advantageous due to a longer proximal sealing, but morbidity is usually higher. Supracoeliac proximal sealing was found to be safe and effective for treating JAAAs, with peri-operative and midterm outcomes comparable with infracoeliac proximal sealing. Future studies and extended long term follow up are required to determine whether supracoeliac sealing results in a more durable exclusion of the aneurysm sac.
Objective: The aim of this study was to investigate peri-operative and midterm outcomes, including sac dynamics, of fenestrated endovascular aortic repair (FEVAR) for juxtarenal abdominal aortic aneurysms (JAAAs), comparing supracoeliac with infracoeliac sealing. Supracoeliac sealing may offer an advantage due to a longer proximal sealing zone, but it is associated with a more complex procedure and increased risk of complications. Furthermore, it is unknown whether supracoeliac sealing actually leads to increased durability.
Methods: Patients undergoing elective FEVAR for JAAAs from 2008 - 2021 at two hospitals in the Netherlands were included. The definition of supracoeliac sealing was sealing in zone 5 or 6, with incorporation of the coeliac axis. Infracoeliac sealing was defined below zone 6. The primary endpoints included peri-operative outcomes. Secondary endpoints included one year aneurysm sac dynamics, freedom from secondary intervention, five year mortality, and sac dynamics over time.
Results: Among 167 patients, 78 (46.7%) had a proximal sealing at an infracoeliac level and 89 (53.3%) at a supracoeliac level. Median proximal sealing length was 37 (interquartile range [IQR] 28, 52) mm for the supracoeliac group and 26 (IQR 19, 34) mm for the infracoeliac group. Patients with supracoeliac sealing more often had prior endovascular aortic aneurysm repair (31% vs. 12%; p = .004). Type IIIc endoleaks only occurred in patients with supracoeliac sealing (6% vs. 0%; p = .03). Other peri-operative complications and mortality were similar between the groups. Furthermore, no significant differences were found in one year aneurysm sac dynamics, freedom from secondary interventions, five year mortality, and sac dynamics over time.
Conclusion: Proximal supracoeliac and infracoeliac sealing showed similar midterm outcomes, including sac dynamics, despite the higher procedural complexity of supracoeliac sealing. Supracoeliac sealing had a higher rate of 30 day type IIIc endoleak, but no difference in five year secondary intervention rate. Theoretically, supracoeliac sealing may be advantageous as sealing zones dilate over time, although future studies with longer than five year follow up are needed to determine its impact on long term aneurysm sac exclusion.
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http://dx.doi.org/10.1016/j.ejvs.2024.11.019 | DOI Listing |
Eur J Vasc Endovasc Surg
November 2024
Erasmus University Medical Center, Rotterdam, the Netherlands.
Unlabelled: This retrospective observational study using clinical data from two large hospitals in the Netherlands evaluated midterm outcomes of fenestrated endovascular aortic repair for juxtarenal abdominal aortic aneurysms (JAAAs), comparing supracoeliac with infracoeliac sealing. Supracoeliac sealing is considered advantageous due to a longer proximal sealing, but morbidity is usually higher. Supracoeliac proximal sealing was found to be safe and effective for treating JAAAs, with peri-operative and midterm outcomes comparable with infracoeliac proximal sealing.
View Article and Find Full Text PDFEur J Vasc Endovasc Surg
May 2019
Complex Aortic Team, Birmingham Heartlands Hospital, The Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. Electronic address:
Objective: To report the outcome of elective fenestrated and branch (FEVAR-BEVAR) endovascular aortic repair with supracoeliac (SC) sealing zones and the impact of staged repair without prophylactic cerebrospinal fluid (CSF) drainage on the incidence of spinal cord ischaemia (SCI).
Methods: Two hundred and seventy consecutive patients (217 men; mean [SD] age, 72.8 ± 6.
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