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 SS2. A Propensity-Matched Comparison of Fenestrated EVAR and Open Surgical Repair of Complex Abdominal Aortic Aneurysms

Maxime Raux1, Virendra I. Patel2, Frederic Cochennec1, Shankha Mukhopadhyay2, Pascal Desgranges1, Richard P. Cambria2, Jean-Pierre Becquemin1, Glenn M. LaMuraglia2
1Henri Mondor Hospital, Creteil, France; 2Massachusetts General Hospital, Boston, MA.
 
OBJECTIVES: The benefit of fenestrated EVAR (FEVAR) to open surgery repair (OR) of complex abdominal aortic aneurysm (CAAA) is unknown. This study compares 30-day outcomes of these procedures from two high-volume centers, where FEVAR was undertaken for “high risk” patients.
 
METHODS: Patients undergoing commercially available FEVAR and OR of CAAA (total suprarenal/visceral clamp position) were propensity matched to identify demographic/clinical and anatomically similar cohorts. Perioperative outcomes were evaluated using univariate and multivariate methods.
 
RESULTS: From July 1 to Aug. 12, 59 FEVAR and 324 OR patients were identified. Following (1:4) propensity matching for age, gender, hypertension, CHF, CAD, COPD, CVA, diabetes, pre-operative creatinine and anticipated/actual aortic clamp site, the study cohort consisted of 42 FEVAR and 147 open repairs. The most frequent FEVAR construct was 2 renal fenestrations +/- single mesenteric scallop in 50% of cases. Univariate analysis demonstrated FEVAR had a higher 30 day mortality (8.7% vs. 2%; p=0.05), any complication (41% vs. 23%; p=0.01), procedural complication (24% vs. 7%; p<0.01) and graft complication (30% vs. 2%; p<0.01). Multivariate analysis identified FEVAR had an increased 30-day mortality (OR 5.1(95%CI 1.1-24); p=0.04), risk of any complication (OR 2.3(95%CI 1.1-4.9); p=0.01) and graft complication (OR 24(95%CI 4.8-66); p<0.01).
 
CONCLUSIONS: FEVAR, in this 2-center study, is associated with a significantly higher risk of perioperative mortality and morbidity than OR in CAAA. These data suggest that extension of the paradigm comparing EVAR to OR for routine AAA to patients with CAAA is not appropriate. Studies should first establish proper patient selection for FEVAR over OR before widespread use should be considered.
 
AUTHOR DISCLOSURES: J. Becquemin: Nothing to disclose; R. P. Cambria: Nothing to disclose; F. Cochennec: Nothing to disclose; P. Desgranges: Nothing to disclose; G. M. LaMuraglia: Nothing to disclose; S. Mukhopadhyay: Nothing to disclose; V. I. Patel: Nothing to disclose; M. Raux: Nothing to disclose.
 
Posted April 2013

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VascularWeb® is the prime source for all vascular health and disease information, and is presented by the Society for Vascular Surgery®. Its members are vascular surgeons, specialists, and vascular health professionals who are specialty-trained in all treatments for vascular disease including medical management, non-invasive procedures, and surgery.