ArticleAnnals of surgery2026
Long-term Outcomes of Fenestrated and Branched Endovascular Aortic Repair for Complex Aortic Aneurysms in a High-volume Aortic Center.
Article in Annals of surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveThis study presents the experience of a high-volume aortic center on fenestrated/branched endovascular aortic repair (f/bEVAR).
backgroundMaterial and technique evolutions in f/bEVAR improved its outcomes but long-term data is limited.
methodsFollowing 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.
resultsA total of 916 patients were included (73.6% males, 71.7±0.6 y, 81.7% degenerative; 20.8% urgent). Juxtarenal aneurysms were managed in 33.5% and thoracoabdominal (TAAA) in 54.1%. 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% nonrecovery 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.
conclusionsUrgencies 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.
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