Objective

To report the outcomes of redo fenestrated and/or branched endovascular aortic repair (F/BEVAR in FEVAR) to rescue previous failed FEVAR.

Methods

Retrospective review of all consecutive patients undergoing F/BEVAR in FEVAR at eight aortic centres including pre-, intra-, and post-operative data according to a pre-established protocol. Follow up consisted of at least yearly computed tomography angiography. Values are presented as median and interquartile range, and survival as estimate ± standard error in percentage.

Results

18 male patients (76 years old; range 69 – 78 years) receiving FEVAR involving two (two or three) target vessels between 2006 and 2016 underwent F/BEVAR in FEVAR between 2012 and 2019 (aneurysm diameter of 63 mm; range 56 – 69 mm). Median interval between the procedures was 53 (29 – 103) months. The indication for F/BEVAR in FEVAR was type Ia endoleak in 16 cases (eight isolated and eight combined with graft migration), one graft migration without endoleak and one migration with significant proximal aortic expansion. F/BEVAR in FEVAR involved all patent renovisceral arteries and had an operating time of 260 (204 – 344) minutes. Technical success was achieved in 15 (83%) cases. There was a failure to bridge one renal artery, one renal capsular bleed with the subsequent need for renal artery embolisation within 24 hours and one persistent type Ib endoleak despite iliac extension. There was no peri- or in hospital death. Two patients developed spinal cord ischaemia, one transient paraparesis and one permanent paraplegia. The latter occurred in a non-staged procedure where spinal drainage was used. During a follow up of 27 (7 – 39) months, three (17%) patients underwent late re-interventions. Overall survival at 24 months was 70 ± 11% with no aneurysm related death and a secondary clinical success at 24 months of 84 ± 11%.

Conclusion

F/BEVAR in FEVAR is a technically challenging but feasible solution to rescue failed FEVAR. The outcomes are promising in many aortic centres but need to be confirmed by further studies with longer follow up.

中文翻译：

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编辑推荐——重做开窗/分支血管内动脉瘤修复以挽救失败的开窗内移植物的多中心结果

客观的

报告重做开窗和/或分支血管内主动脉修复术（FEVAR 中的 F/BEVAR）以挽救先前失败的 FEVAR 的结果。

方法

根据预先制定的协议，对八个主动脉中心在 FEVAR 中接受 F/BEVAR 的所有连续患者进行回顾性审查，包括术前、术中和术后数据。随访包括至少每年一次的计算机断层扫描血管造影。值表示为中位数和四分位距，存活率表示为估计值 ± 标准误差百分比。

结果

18 名男性患者（76 岁；范围 69 – 78 岁）在 2006 年至 2016 年间接受涉及两根（两到三个）靶血管的 FEVAR 患者在 2012 年至 2019 年期间在 FEVAR 中接受了 F/BEVAR（动脉瘤直径为 63 毫米；范围为 56 至 69毫米）。两次手术之间的中位间隔为 53 (29 – 103) 个月。FEVAR 中 F/BEVAR 的适应症为 16 例 Ia 型内漏（8 例孤立，8 例合并移植物移位），1 例移植物移位无内漏，1 例移植伴近端主动脉显着扩张。FEVAR 中的 F/BEVAR 涉及所有未闭的肾内脏动脉，手术时间为 260 (204 – 344) 分钟。在 15 个 (83%) 的案例中取得了技术上的成功。未能桥接一根肾动脉，1 例肾包膜出血，随后需要在 24 小时内进行肾动脉栓塞，1 例 Ib 型内漏持续存在，尽管髂骨延长。没有围或住院期间死亡。两名患者出现脊髓缺血，一名暂时性截瘫和一名永久性截瘫。后者发生在使用脊髓引流的非分期手术中。在 27 (7 – 39) 个月的随访期间，三名 (17%) 患者接受了晚期再干预。24 个月的总生存率为 70 ± 11%，无动脉瘤相关死亡，24 个月的二次临床成功率为 84 ± 11%。在 27 (7 – 39) 个月的随访期间，三名 (17%) 患者接受了晚期再干预。24 个月的总生存率为 70 ± 11%，无动脉瘤相关死亡，24 个月的二次临床成功率为 84 ± 11%。在 27 (7 – 39) 个月的随访期间，三名 (17%) 患者接受了晚期再干预。24 个月的总生存率为 70 ± 11%，无动脉瘤相关死亡，24 个月的二次临床成功率为 84 ± 11%。

结论

FEVAR 中的 F/BEVAR 是一种技术上具有挑战性但可行的解决方案，可以挽救失败的 FEVAR。许多主动脉中心的结果是有希望的，但需要通过更长时间随访的进一步研究来证实。