Early versus late experience in fenestrated endovascular repair for abdominal aortic aneurysm

OBJECTIVE: The objective of this study was to evaluate operative results and 1-year outcomes in early vs late experience after fenestrated endovascular aortic repair.

METHODS: All patients treated in Malmö, Sweden, and in Lille, France, with fenestrated endovascular repair for abdominal aortic aneurysm were prospectively enrolled in a computerized database. Early experience was defined as the first 50 patients treated at each center. Data from early and late experience were retrospectively analyzed and compared for differences in operative results and 1-year outcomes.

RESULTS: Early experience covered 4.7 years in Malmö and 4.5 years in Lille; late experience covered 5.6 years in Malmö and 3.7 years in Lille. A total of 288 patients were included. In the later phase, stent graft configuration was more complex because of increased number of fenestrations/scallops incorporated in the graft design (2.7 ± 0.8 vs 3.2 ± 0.7; P < .001). Despite this, volume of contrast material and radiation time decreased by 27% and 20%, respectively, whereas procedure time remained unchanged. At 1 year, a trend toward decreasing abdominal aortic aneurysm diameter was observed in the late group, but no differences were found in mortality, endoleaks, or target vessel patency between the groups.

CONCLUSIONS: With increasing experience, fenestrated endovascular aneurysm repair design has become more complicated, with more visceral vessels targeted for better proximal seal, while operative risk still remains low. Simultaneously, radiation time and volume of contrast material have been reduced, with possible long-term benefits for the patient.