Perioperative and midterm outcomes of Branched or Fenestrated Endovascular Aneurysm Repair for type 1A endoleak after Endovascular Aneurysm Repair.

Objective: The treatment of a failing Endovascular Aneurysm Repair (EVAR) due to loss of proximal sealing is challenging. Branched or Fenestrated Endovascular Aneurysm Repair (B/FEVAR) offer a promising endovascular solution. This study evaluates B/FEVAR outcomes for managing type 1A endoleak after EVAR.

Methods: All consecutive patients who underwent B/FEVAR surgery to treat a type 1A endoleak after EVAR at a large teaching hospital between 2019 and 2024 were included in this study. Outcomes analyzed included aneurysm-related mortality, overall survival, technical success, endoleaks, aneurysm sac dynamics, re-interventions, target vessel patency, target vessel instability, and other complications. Regular follow-up after B/FEVAR surgery included imaging at 1, 6, and 12 months and annually thereafter.

Results: Among 24 patients (96% males, median age 73 (range: 66-80)), the median interval between EVAR and B/FEVAR was 6.6 years (range: 2-11). No aneurysm-related mortality was observed during follow-up. Median follow-up was 20 months (range: 3-67) and overall survival was 95%. The primary technical success rate was 88%, and the assisted primary technical success rate was 92%. Type 2 endoleaks were observed in 33% of patients, while type 3 endoleaks occurred in 13% of patients. Aneurysm sac regression during follow-up was reported in 17%, stabilization in 71% and expansion in 13% of patients. Re-interventions were required in 25% of patients. Primary target vessel patency and assisted primary target vessel patency were 95% and 97%. Target vessel instability was 8%.

Conclusions: B/FEVAR appears to be a safe, and effective option for managing type 1A endoleaks after prior EVAR based on midterm outcomes.