Comparison of Short- and Mid-Term Follow-Up Between Standard and Fenestrated Endografts

Background This study compared early and mid-term results of endovascular treatment for abdominal aortic aneurysms (AAAs) and pararenal aneurysms (PRAs). Methods Using data from a prospective database, patients treated with endografts for AAA and PRA between January 2007 and December 2009 were analyzed. In both groups, mortality, endoleak rates, evolution of renal function, reintervention rate at 30 days and at mid-term follow-up, and aneurysmal sac evolution at 1 year were compared. Results In total, 379 patients were included: 264 treated for AAA and 115 for PRA. Median follow-up was 24 months (range 12–46 months) in both groups. Risk factors and medical history were comparable in both groups, except for chronic renal failure (higher in the PRA group; P = 0.003). The mortality rates at 30 days were 1% and 3% in the AAA and APR groups, respectively ( P = 0.10). During follow-up, the mortality rates were 11.1% and 12.8% in the AAA and PRA groups, respectively ( P = 0.72). The reoperation rates at 30 days were 8% and 10% in the AAA and PRA groups, respectively ( P = 0.72). During follow-up, the reoperation rates were 9.2% and 9.9% in the AAA and PRA groups, respectively ( P = 0.85). At 1 year, retraction of the aneurysmal sac was diagnosed in 48% of the patients in the AAA group and in 56% of the patients in the PRA group ( P = 0.41). The incidence rates of new postoperative cases of renal insufficiency were 19.3% and 8.1% in the AAA and PRA groups, respectively ( P = 0.008). At 30 days, the endoleak rates were 27.5% and 12.7% in the AAA and PRA groups, respectively ( P = 0.001). At 1 year, the endoleak rates were 19.4% and 7.3% in the AAA and PRA groups, respectively ( P = 0.007). When type II endoleaks were excluded, the endoleak rates were comparable in both groups ( P = 0.5). At 1 year, in both groups, a retraction of the aneurysmal sac was significantly correlated to the absence of endoleak ( P = 0.001). Conclusion Early and mid-term results of AAA treatment with standard endografts and PRA treatment with fenestrated endografts are comparable.