Long-term Outcomes of Fenestrated and Branched Endovascular Aortic Repair for Complex Aortic Aneurysms in A high-volume Aortic Center

OBJECTIVE: This study presents the experience of a high-volume aortic center on fenestrated/branched endovascular aortic repair (f/bEVAR). BACKGROUND: Material and technique evolutions in f/bEVAR improved its outcomes but long-term data is limited. METHODS: Following STROBE, a retrospective single-center study of consecutive (elective/urgent) patients managed with f/bEVAR [custom-made (CMD) and off-the-shelf devices] between 2010 and 2024 was conducted. Technical success, 30-day mortality and spinal cord ischemia (SCI), and follow-up outcomes were analyzed. Multivariate logistic regression analyses were performed. RESULTS: 916 patients were included (73.6% males, 71.7±0.6 y, 81.7% degenerative; 20.8% urgent). Juxtarenal aneurysms were managed in 33.4% and thoracoabdominal (TAAA) in 53.7%. Staging was performed in 26.0%. CMD were used in 74.4% (fenestrated: 37.1%; branched: 28.9%). Technical success was 93.6%, with urgent setting (P<0.001) and TAAA II (P=0.03) being independently associated. Thirty-day mortality was 7.4% (4.4% in elective); independently related to aortic rupture (P=0.03). SCI was 16% (12.7% in elective) with 2.9% non-recovery Grade 3 SCI (2.3% in elective) and related to aortic rupture (P=0.009) and use of off-the-shelf devices (P<0.001). Survival was 82.6% (SE 1.9%) at 60 months. freedom from aorta-related mortality was 89.2% (SE 1.3%) at 48 months. Cox-regression identified age (P=0.002), ASA≥4 (P=0.02) and SCI (P<0.001) related to worse survival. Freedom from any aortic reintervention was 40.0% (SE 2.5%) at 60 months with technical success (P<0.001) being related. CONCLUSION: Urgencies negatively affect the early f/bEVAR outcomes. Grade 3 SCI rate was acceptable, especially in elective cases. Survival was over 80% at 60 months, despite frequent reinterventions.