Editor's Choice - Long Term Outcomes of the Advanta V12 Covered Bridging Stent for Fenestrated and Branched Endovascular Aneurysm Repair in 1 675 Target Vessels

Objective: To report outcomes of the Advanta V12 as a covered bridging stent in fenestrated and branched endovascular aneurysm repair (F/BEVAR). Methods: Patients treated with F/BEVAR and followed in a single centre receiving the Advanta V12 as a covered bridging stent between January 2010 and May 2020 were included. Results: A total of 636 patients (543 men) were analysed. A total of 1 675 target vessels (TVs) were bridged with the Advanta V12. Estimated TV patency at one, five, and eight years was 99.1% + 0.2%, 96.9% + 0.5% and 96.2% + 0.7%, respectively. Estimated patency at eight years was 98.1% + 0.5% for fenestrations and 87.3% + 2.9% for branches (p < .001). Estimated patency of renal arteries was statistically significantly lower for those targeted with branches compared with fenestrations (p = .001). Multivariable analysis showed that targeting a TV with a branch compared with a fenestration was the only independent risk factor for occlusion during follow up (hazard ratio 6.41, 95% CI 3.4 - 11.9; p < .001). Estimated freedom from endoleak at one, five, and eight years was 99.4% + 0.2%, 96.4% + 0.6%, and 95.4% + 0.8%, respectively. Estimated freedom from target vessel instability (TVI) at one, five, and eight years was 98.5% + 0.3%, 93.0% + 0.8%, and 91.3% + 1%, respectively. Estimated freedom from TVI at eight years was 93.2% + 0.9% for fenestrations and 82.7% + 3.5% for branches (p < .001). Estimated freedom from TVI was statistically significantly lower for renal arteries targeted with branches compared with those targeted with fenestrations (p < .001) Conclusion: The Advanta V12 shows excellent technical success rates as a covered bridging stent in F/BEVAR. Late outcomes remain good with low rates of TV occlusion, endoleak, and re-intervention. Renal arteries targeted with branches demonstrated a higher risk of occlusion and instability compared with those targeted with fenestrations.