Short-term and mid-term outcomes after use of the native infrarenal aorta as distal landing zone for fenestrated-branched endovascular aortic repair.

Abstract Introduction This study aimed to examine outcomes after use of the native infrarenal aorta as distal landing zone for fenestrated-branched endovascular aortic repair (F-BEVAR) of pararenal-thoracoabdominal aortic aneurysms (PRAA-TAAA). Methods All F-BEVAR procedures for treatment of PRAA-TAAA (2011-2019) at two aortic centers were examined. The outcomes of interest were: i) technical success; ii) peri-operative morbidity; iii) preservation of lumbar arteries and the inferior mesenteric artery; iv) type IB endoleaks; v) reinterventions; vi) survival; vii) aneurysm sac behavior; and viii) infrarenal aortic changes. Results Twenty consecutive patients with distal landing in the native infrarenal aorta were included (median age 71 years; 25% males). The median number of visible lumbar arteries at baseline was seven and a patent IMA before the operation was present in nineteen (95%) of the cases. There were no deaths within 30 days. One patient (5%), operated on with a 4-BEVAR for a type 2 TAAA, experienced SCI (permanent paraplegia). The median decrease in the number of visible lumbar arteries at the first post-operative scan was three from the baseline value, while a patent IMA was preserved in twelve out of nineteen patients. Only in one case (5%) a type IB endoleak was noted for an overall technical success rate of 95%, which required a standard EVAR 20 months after the initial operation. The median follow-up duration for the study cohort was 491 days; all patients were alive at the longest available individual follow-up and no instances of new-onset type IB endoleaks were observed Another three late reinterventions (in addition to the one mentioned above) were performed during mid-term follow-up, all due to target vessel instability. In patients with ≥12 months of follow-up after the index procedure (n=12, 60% of the entire cohort), no instances of aneurysm sac increase >5 mm were noted; the median largest aortic diameter was 51 mm with a median difference from baseline of -6 mm. The median distal landing zone diameter increase was 4 mm from baseline but never beyond the nominal stent-graft diameter, while the median aortic bifurcation diameter differed 1 mm from baseline. Conclusions This preliminary experience shows that the use of the native infrarenal aorta as a distal landing zone for F-BEVAR is safe in the short- and mid-term in patients with suitable anatomy, allowing the sparing of collateral vessels. Longer follow-up is warranted to assess durability.