1Enrico Mancuso,1Wissam Al-Jundi, 1Wissam Al-Jundi

1Norfolk & Norwich University Hospital

Background(s):

Adequate placement of visceral stents in FEVAR is key to achieve aortic aneurysm sealing, their failure can lead to significant complications and carry a considerable burden of reinterventions. The aim of this study is to identify pre-operative or intraprocedural predictors of visceral stents failure.

Material(s) and Method(s):

Retrospective review of consecutive 72 patients who underwent FEVAR in a single high volume centre over 9 years, between 2013 and 2021 . Outcomes of mortality, failure and reintervention of 217 visceral stents were collected, pre and post-operative imaging was reviewed.

Result(s):

The overall early mortalities at 30 days were 6 (8%) of these 3 (4%) were related to visceral stents failure. Intraprocedural complexity was documented in 11 (15%) cases and 3 (1.4%) fenestrations could not be stented. A significant early type 1c endoleak or acute visceral stent failure was identified in 8 (11%) patients, of these 7 (9.7%) had in-patient re-intervention within 30 days. At 1 year, 11 (15%) patients had  visceral stent reintervention, at 2 years it was 2 (2.8%) and at 3 years it was 2 (2.8%). One case had 2 re-interventions on the same visceral stent. To the dedicated review of the 2017 visceral stents, 20 (9.2%) needed re-intervention, of which 17 (7.8%) were renal stents. When comparing visceral stents with good outcome versus those that needed re-intervention, no significant difference was identified for aneurysm neck diameter (29 +/- 2.6 vs 30.5 +/- 6.4; p=0.49), diameter of target vessels (5.9 +/- 0.2 vs 5.55 +/- 0.5; p=0.34), stent oversize (15% +/- 0.02 vs 13% +/- 0.05; p=0.36) or length of coverage of the target vessels (18 +/- 0.88 vs 16.5 +/- 3.2; p=0.36).

Conclusion(s):

OIn FEVAR the mode of visceral stent failures varies. Their complications and reinterventions are common and unpredictable, therefore a close surveillance must be continued long term.