Two-year outcomes of fenestrated and branched stent grafts in patients ≤65 years: A bicenter retrospective study.

Abstract

Fenestrated and branched endovascular aortic repair (F/BEVAR) is increasingly used to treat complex abdominal aortic aneurysms and thoracoabdominal aortic aneurysms (TAAAs) because of their minimally invasive nature compared with open repair. However, data on outcomes in young patients remain limited. The aim of this study was to report 24-month outcomes in patients ≤65 years of age who underwent F/BEVAR. This retrospective bicenter cohort study included consecutive patients treated for complex abdominal aortic aneurysm or TAAA with F/BEVAR between 2016 and 2023 at Nantes and Rennes University Hospitals. Preoperative, intraoperative, and postoperative data were prospectively collected. Data were compared between patients ≤65 years of age and those >65 years of age. Follow-up analyses were performed at 24 months. Among the 254 patients included, 24.8% were aged ≤65 years (n = 63). In the preoperative assessment, patients ≤65 years more frequently had TAAA (44.4% vs 19.9%; P < .001), a history of aortic dissection (19.0% vs 4.2%; P < .001), and prior aortic surgery (43.0% vs 28.0%; P = .046). Primary technical success was similar between the groups (96.8% vs 94.2%; P = .632). Thirty-day all-cause mortality was 3.2% in patients ≤65 years, similar to that observed in patients >65 years (4.2%; P = .90). Rates of postoperative medical complications within 30 days were also comparable, including acute kidney injury (7.9% vs 8.4%) and paraplegia (1.6% vs 0%). Surgical complications were mainly access related (6.3% vs 4.7%), with no significant difference between groups ( P = .57). At 2 years, rates of endoleaks, stent occlusion, and reintervention for any cause were similar between groups. However, endovascular reintervention for branch stent placement was more frequent in patients ≤65 years (30.2% vs 10.5%; P < .001). Twenty-four-month mortality was 13.0% (11.1% vs 13.6%; P = .620). A trend toward greater aneurysm sac regression was observed in younger patients (-10.1% vs -4.4%; P = .10). Overall, outcomes after F/BEVAR were similar in patients ≤65 years of age compared with older patients, despite more extensive aneurysmal disease at baseline. The need for close surveillance of target vessels in these patients is confirmed, consistent with the higher prevalence of underlying and progressive aortic dissection.