Systematic review and meta-analysis on the outcomes after fenestrated-branched endovascular repair in post-dissection thoracoabdominal aortic aneurysms.

In 30 seconds

This systematic review and random-effects meta-analysis assessed clinical and target-vessel outcomes after fenestrated or branched endovascular repair for post-dissection thoracoabdominal aortic aneurysms. It included 17 retrospective studies with 912 patients and 3229 target vessels. Technical success was 96.0%; after a mean follow-up of 23.5 months, pooled target-vessel instability was 7.6% and target-vessel reintervention was 6.9%. Outcome heterogeneity prevented direct comparison of fenestrated with branched repair. The authors considered the approach viable, while identifying target-vessel durability, particularly for renal arteries, as an ongoing concern.

Key findings

• Across 17 retrospective studies, technical success was 96.0% among 912 patients.
• Pooled major adverse events were 4.6%, and early mortality was 4.1%.
• After a mean follow-up of 23.5 months, pooled mortality was 12.8%, target-vessel instability 7.6%, and target-vessel reintervention 6.9%.
• Renal arteries had higher reported target-vessel instability and reintervention rates than visceral arteries; heterogeneity precluded direct comparison of FEVAR and BEVAR.

Why it matters

These pooled results provide an overview of outcomes for a complex aneurysm population treated with fenestrated or branched endovascular repair. High technical success supports its consideration as an endovascular strategy, but target-vessel events and midterm mortality remain relevant outcomes. The reported renal-vessel durability concern and variation in outcome reporting underscore the need for careful follow-up and more consistent evidence.

What to keep in mind

All included studies were retrospective, outcome reporting was heterogeneous, and mean follow-up was 23.5 months. The heterogeneity prevented direct comparison between FEVAR and BEVAR.