Ref.
A propensity-matched comparison of outcomes for fenestrated endovascular aneurysm repair and open surgical repair of complex abdominal aortic aneurysms
EJVES Apr 2015
These figures are shockingly true, and has to be always taken into account when a patient is offered a FEVAR, especially our octogenarians.
Raux et al.11 compared F-EVAR with open surgery in patients with complex AAA in two large volume centres: In this study,
- F-EVAR had higher 30 day mortality rates (9.5% vs. 2%),
- higher procedural complications (24% vs. 7%)
- and graft related complications (30% vs. 2%) than open surgery.
The authors conceded that “the learning curve of the endovascular technique was likely to be responsible in part for the adverse outcomes observed in the F-EVAR cohort”
The WINDOWS multicentre French Registry reported outcomes in 268 patients who received F-EVAR or B-EVAR for juxtarenal AAA (group 1), suprarenal AAA and TAAA Type IV (group 2), and TAAA Type I, II, III (group 3).15 In hospital mortality was 6.5% for group 1 patients, 14.3% for group 2, and 21.4% for group 3.
This paper suggests that more complex aortic endovascular procedures (especially branched repair of TAAAs) should be focused within higher volume institutions that can provide all treatment options, have experience in dealing with technically challenging intra-operative problems and where multidisciplinary cooperation is such that the choice of treatment is not influenced by specialty, political, or financial aspects.
I personally fully agree .. the amount of complex parameters involved in the treatment of those patients is huge … and require a lot of experience and high level thinking/planning… as well as a relaxed time in the sub-sub-sub specialty in vascular surgery …. for best outcome to be achieved,.