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Predictors of Sac Regression after Fenestrated Endovascular Aneurysm Repair. Journal of vascular surgery Li, M., Stern, J. R., Tran, K., Deslarzes-Dubuis, C., Lee, J. T. 2021

Abstract

Aneurysm sac regression after standard endovascular aortic repair is associated with improved outcomes, but similar data are limited after fenestrated endovascular aortic repair (FEVAR). We sought to evaluate sac regression after FEVAR, and identify any predictors of this favorable outcome.Patients undergoing elective FEVAR using the commercially available Zenith Fenestrated device (ZFEN; Cook Medical, Bloomington, IN) from 2012 to 2018 at a single institution were retrospectively reviewed. Maximal aortic diameter was compared between the preoperative scan and those obtained in follow-up. Patients with =5 mm sac regression were included in the REG group, with all others in the NON-REG group. Outcomes were compared between groups using univariate analysis, and logistic regression analysis was performed to identify any predictive factors for sac regression.132 FEVAR patients were included in the analysis. At a mean follow-up of 33.1 months, 65 patients (49.2%) had sac regression =5 mm and comprised the REG group (N=65, 49.2%). The REG group had smaller diameter devices, and were less likely to have had concomitant chimney grafts placed (P <0.05). The NON-REG group had a higher incidence of type II endoleak (35.8% vs. 12.3%; P=0.002). Sac regression was associated with a significant mortality benefit on Kaplan-Meier analysis (log rank; P=0.02). Multivariate analysis identified adjunctive parallel grafting (OR 0.01, 95% CI 0.03-0.36; P <0.01), persistent type II endoleak (OR 0.13, 95% CI 0.02-0.74; P <0.01), and increased number of target vessels (OR 0.25, 95% CI 0.10-0.62, P=0.002) as independent predictors of failure to regress.Sac regression after FEVAR occurred in nearly half of patients, but appears to be less common in patients with persistent type II endoleaks and those undergoing concomitant parallel grafting. Sac regression was associated with a significant survival advantage, and can be used as a clinical marker for success after FEVAR.

View details for DOI 10.1016/j.jvs.2021.08.067

View details for PubMedID 34506890