Can You Predict the Unpredictable?: Visceral Stent Reintervention in Fenestrated Endovascular Repair of Juxta-Renal Aneurysms

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Background: Adequate placement of visceral stents in fenestrated endovascular aortic aneurysm repair (FEVAR) is key to achieve aortic aneurysm sealing; their failure can lead to significant complications and carry a considerable burden of reinterventions. The aim of this study is to identify preoperative or intraprocedural predictors of visceral stents failure. Materials and Methods: Retrospective review of consecutive 72 patients who underwent FEVAR in a single high-volume center over 9 years, between 2013 and 2021. Outcomes of mortality, failure, and reintervention of 217 visceral stents were collected; pre- and postoperative imaging was reviewed. Result: The overall early mortalities at 30 days were 6 (8%) and of these 3 (4%) were related to visceral stents failure. Intraprocedural complexity was documented in 11 (15%) cases and 3 (1.4%) fenestrations could not be stented. A significant early type 1c endoleak or acute visceral stent failure was identified in 8 (11%) patients, and of these 7 (9.7%) had in-patient reintervention within 30 days. At 1 year, 11 (15%) patients had visceral stent reintervention, and at 2 years it was 2 (2.8%) and at 3 years, it was 2 (2.8%). One case had two reinterventions on the same visceral stent. To the dedicated review of the 2017 visceral stents, 20 (9.2%) needed reintervention, of which 17 (7.8%) were renal stents. When comparing visceral stents with good outcome versus those that needed reintervention, no significant difference was identified for aneurysm neck diameter (29 ± 2.6 vs. 30.5 ± 6.4; p = 0.49), diameter of target vessels (5.9 ± 0.2 vs. 5.55 ± 0.5; p = 0.34), stent oversize (15% ± 0.02 vs. 13% ± 0.05; p = 0.36) or length of coverage of the target vessels (18 ± 0.88 vs. 16.5 ± 3.2; p = 0.36). Conclusions: In FEVAR, the mode of visceral stent failures varies. Their complications and reinterventions are common and unpredictable; therefore, a close surveillance must be continued long term. Publication History Article published online: 17 August 2022 © 2022. The Pan Arab Interventional Radiology Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) Thieme Medical and Scientific Publishers Pvt. Ltd. A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

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