title: Long-term follow-up of fenestrated endovascular repair for juxtarenal aortic aneurysm.
abstract: BACKGROUND
  Fenestrated endovascular aneurysm repair (FEVAR) is increasingly being used for juxtarenal aortic aneurysms. The aim of this study was to review long-term results and assess the importance of changing stent-graft design on outcomes.
  
  
  METHODS
  This was a retrospective review of all patients who underwent FEVAR within a single unit over 12 years (February 2003 to December 2015). Kaplan-Meier analysis of survival, and freedom from target vessel loss, aneurysm expansion, graft-related endoleak and secondary intervention was performed. Comparison between outcomes of less complex grafts (fewer than 3 fenestrations) and more complex grafts (3 or 4 fenestrations) was undertaken.
  
  
  RESULTS
  Some 173 patients underwent FEVAR; median age was 76 (i.q.r. 70-79) years and 90·2 per cent were men. Median aneurysm diameter was 63 (59-71) mm and median follow-up was 34 (16-50) months. The adjusted primary technical operative success rate was 95·4 per cent. The in-hospital mortality rate was 5·2 per cent; there was no known aneurysm-related death during follow-up. Median survival was 7·1 (95 per cent c.i. 5·2 to 8·1) years and overall survival was 60·1 per cent (104 of 173). There was a trend towards an increasing number of fenestrations in the graft design over time. In-hospital mortality appeared higher when more complex stent-grafts were used (8 versus 2 per cent for stent-grafts with 3-4 versus fewer than 3 fenestrations; P = 0·059). Graft-related endoleaks were more common following deployment of stent-grafts with three or four fenestrations (12 of 90 versus 6 of 83; P < 0·001).
  
  
  CONCLUSIONS
  Fenestrated endovascular aneurysm repair for juxtarenal aneurysm is associated with few aneurysm-related deaths in the long term. Significant numbers of secondary interventions are required, but the majority of these can be performed using an endovascular approach.
authors.affiliation: Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK.|Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.
authors.forename: I N
authors.identifier: http://orcid.org/0000-0001-9701-8319
authors.initials: IN
authors.lastname: Roy
authors.affiliation: Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: A M
authors.initials: AM
authors.lastname: Millen
authors.affiliation: Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: S M
authors.initials: SM
authors.lastname: Jones
authors.affiliation: Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK.|Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.
authors.forename: S R
authors.initials: SR
authors.lastname: Vallabhaneni
authors.affiliation: Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: J R H
authors.initials: JRH
authors.lastname: Scurr
authors.affiliation: Interventional Radiology, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: R G
authors.initials: RG
authors.lastname: McWilliams
authors.affiliation: Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: J A
authors.initials: JA
authors.lastname: Brennan
authors.affiliation: Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: R K
authors.initials: RK
authors.lastname: Fisher
mesh_terms: D000359:Aftercare; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000639:trends; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000401:mortality; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011474:Prosthesis Design / Q000401:mortality / Q000639:trends; D012189:Retrospective Studies; D015607:Stents / Q000639:trends*; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000378:metabolism; D016019:Survival Analysis