Impact of Stent-Graft Complexity on Outcomes of Complex Abdominal Aortic Aneurysm Repair: A Systematic Review and Meta-Analysis

This systematic review revealed no significant difference in mortality, complications, or reintervention between renal FEVAR and complex FEVAR. Renal FEVAR in juxtarenal aneurysms remains a safe and effective treatment option with no higher risk on type Ia endoleak or reinterventions during follow-up compared with complex FEVAR. The current data do not provide a clear understanding of the long-term benefits associated with complex FEVAR compared with renal FEVAR.Clinical ImpactThis systematic review found no significant differences in mortality, complications, or reinterventions between renal and complex FEVAR. The results indicate that renal FEVAR remains an effective option for appropriately selected patients, and that the added complexity of incorporating mesenteric vessels does not necessarily translate into improved outcomes. Current evidence does not clarify whether complex FEVAR provides long-term advantages over renal FEVAR. These findings underscore the importance of anatomy-driven, individualized decision-making in complex aortic aneurysm repair.