Comparison of fenestrated endovascular aneurysm repair and chimney graft techniques for pararenal aortic aneurysm

Objective: This study compared early-term and midterm results of endovascular repair (EVAR) of juxtarenal or pararenal aortic aneurysms (PAAs) using fenestrated stent grafting (f-EVAR) and the chimney grafting (c-EVAR) technique. Methods: Consecutive patients with PAAs who underwent f-EVAR using commercially available devices and c-EVAR in a tertiary vascular center from January 2006 to April 2013 were evaluated, including a retrospective scrutiny and update of a prospectively maintained database, calculation and comparison of perioperative mortality and morbidity, overall survival, reintervention-free rate, branch event-free rate, reconstructed vessel patency, and collection of data about intraoperative events, perioperative complications and reinterventions, and midterm sac behavior. Results: During the study period, 80 patients (72 men) underwent f-EVAR and 38 (34 men) underwent c-EVAR. All f-EVAR patients were operated on electively, whereas six c-EVAR patients (15.8%; P =.002) were operated on in an emergent setting. The preoperative PAA diameter was significantly smaller in the f-EVAR group than in the c-EVAR group (58.6 +/- 8.6 mm vs 65.9 +/- 15.3 mm; P =.003). The mean number of reconstructed vessels per patient was 2.4 +/- 0.7 (median, two) for the f-EVAR group and 1.6 +/- 0.7 (median, one) for the c-EVAR group (P <.0001). The f-EVAR and c-EVAR groups did not differ in 30-day mortality (6.3% vs 7.9%; P =.71) or in moderate to severe complications (27.5% vs 39.5%; P =1.0). Median follow-up duration was 14 months, (range, 0-88 months) in the f-EVAR group and 12 months (range, 0-48 months) in the c-EVAR group. After 2 years, estimated survival rates (77.3% vs 71.8%), reintervention-free rates (71.4% vs 72.0%), reconstructed vessel event-free rates (90.5% vs 84.1%), and primary patency of reconstructed vessel rates (97.1% vs 87.6%) were not statistically different. During follow-up, sac shrinkage (>= 5 mm) was observed in 43.4% of f-EVAR patients and in 30.6% of c-EVAR patients (no statistical difference). Conclusions: In this limited retrospective series, short-term and midterm results of f-EVAR and c-EVAR were not statistically different. c-EVAR could be an attractive option for patients not suitable for f-EVAR.