A non-systematic review of the early, mid, and long-term outcomes for fenestrated and branched endovascular repair of thoracoabdominal aneurysms.

Background Over the last two decades the development of fenestrated and branched aortic endografts has enabled endovascular repair of thoracoabdominal aneurysms in high surgical risk patients. F/BEVAR has demonstrated acceptable early and midterm outcomes, however challenges include bridging stent instability and a high rate of reintervention. Evaluating the long-term outcomes and durability of F/BEVAR is important for broader application of this technology. Methods We conducted a comprehensive, non-systematic, review of the literature reporting on the early, mid, and earl-long term outcomes for branched and fenestrated endovascular repair of thoracoabdominal aneurysms. The authors achieved consensus on the studies reviewed. Studies were evaluated based on the type and extent of aneurysms treated, long term mortality, reintervention, and branch graft instability, although no pooled data analysis was performed. Results Retrospective cohort studies have reported a short-term mortality benefit for F/BEVAR in anatomically suitable high surgical risk patients. In the studies reviewed, overall survival after FEVAR ranged from 81-100% at 1 year, 32-76% at 5 years, and 33-52% at 7 years. Freedom from reintervention after FEVAR ranged from 38-91% at 3 years, and 50%-80% at 5 years. Bridging stent graft instability resulting in endoleak remain a significant clinical challenge and a primary driver of reintervention. Reports of target vessel patency ranged 89-96% at 3-years, and 86-99% at 5-years. Conclusion Thoracoabdominal aneurysms present a challenging pathology associated with significant morbidity and mortality after surgical repair. Fenestrated and branched endovascular repair has enabled minimally invasive repair in high surgical risk patients and has demonstrated acceptable short and midterm outcomes including an early survival benefit, and a low rate of aortic-related mortality. F/BEVAR has also been associated with a higher rate of long-term reinterventions. Main body endoleak from progressive degeneration and branch graft instability have emerged as the primary drivers of long-term reintervention.