Fenestrated/Branched endovascular repair after failed endovascular aortic repair has similar perioperative outcomes to primary repairs.

Objective: To evaluate the outcomes of fenestrated-branched endovascular aortic repair (FB-EVAR) in patients undergoing reintervention for failed endovascular aneurysm repair (EVAR) compared to those undergoing primary FB-EVAR.

Methods: Patients undergoing FB-EVAR between 2014 and 2024 were identified in the Vascular Quality Initiative (VQI) database. Patients were then divided into two groups, those undergoing FB-EVAR after failed EVAR and those undergoing primary FB-EVAR. Baseline characteristics, operative details, and outcomes were compared between groups. Primary outcomes included mortality, reintervention, and endoleak (Type I/III) rates. Secondary outcomes included perioperative complications. Kaplan-Meier survival analysis and Cox regression were used to evaluate 1-year outcomes.

Results: A total of 2067 patients were included in this study, 386 (18.6%) underwent F/BEVAR after failed EVAR, while 1,681 (81.4%) underwent primary FB-EVAR. In the failed EVAR group, perioperative mortality (3.1% vs. 4%, p=0.934) and rates of Type I/III endoleaks (6.5% vs 8.6%, p=0.164) were comparable to that of no prior EVAR. At 12-month follow-up, mortality rates remained similar (17.2% vs. 15.8%, p=0.265), However, patients with prior EVAR had a significantly higher reintervention rates (HR 1.60, 95% CI 1.10-2.35, p=0.015), despite similar mortality and endoleak rates.

Conclusions: FB-EVAR is a safe and effective reintervention strategy following failed EVAR, achieving similar mortality and endoleak outcomes compared to primary FB-EVAR. However, the significantly higher reintervention rates in patients with prior EVAR may be related to the increased complexity this population.