title: Outcomes of fenestrated endovascular repair of juxtarenal aortic aneurysm.
abstract: OBJECTIVE
  To evaluate late outcomes after fenestrated endovascular aortic repair (f-EVAR) in a tertiary European referral center.
  
  
  METHODS
  In 2009, we published short- and midterm results after f-EVAR in the first 54 patients treated with this technique at our center between September 2002 and June 2007. In this paper, we provide long-term follow-up of the same patient cohort with the main focus on target vessel (TV) patency, renal function, reinterventions, and survival.
  
  
  RESULTS
  A total of 54 patients were included in this study. Median age was 72 years (interquartile range [IQR], 68-76 years) at primary operation, and 85% were men. Median preoperative aneurysm diameter was 60 mm (IQR, 53-66 mm). One hundred thirty-four vessels were targeted (mean, 2.5 per patient), and 96 TV stents were placed. The median clinical follow-up was 67 months (IQR, 37-90 months), and computed tomography follow-up was 60 months (IQR, 35-72 months). Aneurysm diameter decreased ≥ 5 mm in 39% ± 7% at 12 months, 64% ± 8% at 36 months, and 71% ± 8% at 60 months. Primary TV patency was 94% ± 2% at 12 months, 91% ± 3% at 36 months, and 90% ± 3% at 60 months. Glomerular filtration rate decreased by 17% at 59 months (IQR, 26-73 months) follow-up (60 [IQR, 46-79] vs 50 [IQR, 38-72] mL/min/1.73 m(2); P < .001), and one patient became dialysis-dependent secondary to a renal stent occlusion. Reintervention-free survival was 88% ± 5% at 12 months, 69% ± 7% at 36 months, and 56% ± 5% at 60 months. At least one reintervention was done in 37% of patients, of which 29% were endoleak-related, 26% TV-related, 13% graft-limb-related, and 32% due to other causes. The majority of reinterventions (68%) were based on complications detected on routine follow-up. Estimated overall survival was 93% ± 4% at 12 months, 76% ± 6% at 36 months, and 60% ± 7% at 60 months. In total, 54% of the patients died during the 10-year study period, where 9% died of aneurysm-related causes.
  
  
  CONCLUSIONS
  Long-term mortality after f-EVAR is high, but most patients die from nonaneurysmal causes. Aneurysm-related mortality is associated with technical complications that can be reduced with increased experience. Reinterventions are common, and most complications are detected on routine follow-up.
authors.affiliation: Vascular Center, Skåne University Hospital, Malmö, Sweden. Electronic address: thorark@hotmail.com.
authors.forename: Thorarinn
authors.initials: T
authors.lastname: Kristmundsson
authors.affiliation: Vascular Center, Skåne University Hospital, Malmö, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Sonesson
authors.affiliation: Vascular Center, Skåne University Hospital, Malmö, Sweden.
authors.forename: Nuno
authors.initials: N
authors.lastname: Dias
authors.affiliation: Vascular Center, Skåne University Hospital, Malmö, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Törnqvist
authors.affiliation: Vascular Center, Skåne University Hospital, Malmö, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Malina
authors.affiliation: Vascular Center, Skåne University Hospital, Malmö, Sweden.
authors.forename: Timothy
authors.initials: T
authors.lastname: Resch
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D012307:Risk Factors; D015607:Stents; D013548:Sweden; D062606:Tertiary Care Centers; D013997:Time Factors; D036542:Tomography, Spiral Computed; D016896:Treatment Outcome; D014654:Vascular Patency