Use of Fenestrated/Branched Devices for Rescue of Proximal Endograft Failure After Endovascular Aneurysm Repair: A Systematic Review of the Literature and an Updated Meta-Analysis.
Spyridon N Mylonas, Vasileios Papavlasopoulos, Konstantinos G Moulakakis et al.
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In 30 seconds
This systematic review and meta-analysis assessed fenestrated or branched endovascular aneurysm repair (F/BEVAR) to treat proximal endograft failure after prior EVAR. It included 16 studies with 1079 patients. Pooled technical success was 94.4% (95% CI 92.5-95.8), and 30-day/in-hospital mortality was 3.9% (95% CI 2.9-5.4). Estimated survival at 36 months was 72.2% (95% CI 66.7-77.2), while freedom from reintervention was 59.3% (95% CI 36.5-78.7), indicating that reinterventions remain a concern despite high technical success.
Key findings
- Pooled technical success was 94.4% (95% CI 92.5-95.8) across 16 studies and 1079 patients.
- Pooled 30-day/in-hospital mortality was 3.9% (95% CI 2.9-5.4).
- Estimated 36-month survival was 72.2% (95% CI 66.7-77.2), and freedom from reintervention was 59.3% (95% CI 36.5-78.7).
- Pooled rates included 1.6% (95% CI 0.8-3.0) for permanent paraplegia and 4.4% (95% CI 3.2-6.1) for new dialysis.
Why it matters
The findings summarize outcomes for a complex rescue procedure used when proximal sealing fails after EVAR. High pooled technical success supports its feasibility, but the reported mortality and declining freedom from reintervention over time underscore that procedural success does not ensure durable repair. These estimates can inform discussions of expected outcomes while recognizing that they aggregate published studies.
What to keep in mind
The meta-analysis included only studies reporting at least 10 patients and at least one major outcome; the abstract does not describe randomised comparisons.