Fenestrated Endovascular Aortic Repair and Open Surgical Repair in Patients with Type Ia Endoleak after Endovascular Aneurysm Repair: a French Multicentre Cohort Study with Propensity Score Matching

OBJECTIVE: This study aimed to report the midterm results of fenestrated endovascular aortic repair (FEVAR) and open surgical repair (OSR) following failed endovascular aneurysm repair with type Ia endoleak. METHODS: An observational multicentre study was conducted in 13 French university centres, with 88 FEVARs and 120 OSRs in 208 patients. After propensity score matching, 136 matched patients were analysed. RESULTS: The thirty day mortality rate was higher in the OSR group than the FEVAR group (7% vs. 3%; p = .24). Thirty day complications were statistically significantly higher in the OSR group for kidney injury (p = .001) and respiratory failure (p = .029). The rate of paraplegia was statistically significantly higher after FEVAR (6% vs. 0%, p = .042). Type Ia endoleak treatment was achieved in 67 of 68 FEVAR patients and in all OSR patients. Survival at two years was comparable between groups, being 88 ± 4% for OSR and 94 ± 3% for FEVAR (p = .83). Re-intervention free survival at two years was higher in the OSR group vs. the FEVAR group (86 ± 4% vs. 73 ± 6%; log rank, p = .037). Irrespective of the technique used, freedom from late re-intervention at two years was statistically significantly higher in patients without persistent type II endoleak (T2EL) (84 ± 6%) compared with those with persistent T2EL (43 ± 9%) (log rank, p < .001). Re-interventions occurred in 36 patients (26.5%), 30 of 68 (44%) in the FEVAR group and six of 68 (9%) in the OSR group (p < .001). Following FEVAR, aneurysm sac thrombosis was achieved in 16 of 68 patients (24%). Cox proportional hazards showed that OSR was associated with a lower probability of late re-interventions compared with FEVAR (hazard ratio [HR] 0.27, 95% confidence interval [CI] 0.11 - 0.69; p = .006) and that persistent T2EL had a greater probability of re-intervention (HR 3.09, 95% CI 1.49 - 6.41; p = .002). CONCLUSION: In this multicentre study with propensity matching, death and complications at 30 days were higher in the OSR group, and FEVAR was associated with more late re-interventions, particularly in patients with concomitant persistent T2EL.