SRS218 - Outcome of fenestrated endovascular abdominal aortic aneurysm repair with unstented celiac artery fenestration—a single centre experience

Abstract Background FEVAR is increasingly being used for treatment of J/SAAA,supraceliac sealing usually necessitates fenestrations with covered bridging stents to the patent main visceral branches including CA, which is the most cephalad and usually furthest from aneurysmal change.Anatomically, CA often presents with a steep take off angle and early splitting branches with accompanying technical challenges to cannulation. Methods This is single centre interventional study, 52 patients with asymptomatic J/SAAA and underwent elective 4xFEVAR between January 2020 and November 2024 using Zenith Cook ® customised 4-Fen FEVAR devices.Patients' data and imaging studies were analysed to evaluate the outcome of CA bridging stent sparing.Intraoperative technical success,endoleak on completion angiogram, CA patency,graft failure/occlusion,and subsequent significant type 1C/3 endoleak,sac expansion,reintervention and spinal cord ischemia were assessed. Results 47 patients(90%) out of 52 had 4xFEVAR without CA stenting,technical success was achieved in all of them with no major intraoperative complication,with average hospital stay of 3 days.Primary CA patency was achieved in all cases throughout the study period. 50 patients (96%) had no re-intervention needed,only one patient (2%) developed significant sac expansion coming from celiac artery type 2 endoleak and needed reintervention with celiac artery stenting and one patient (2%) developed sac expansion coming from IMA type 2 endoleak and needed IMA coiling. Conclusions Quadruple FEVAR repair inclusive of unstented CA fenestration is feasible and associated with high technical success rate, durability, CA patency and short hospital stay. The endoleak rate is low with minimal reintervention, and acceptably low morbidity and mortality.