LAUSR

Early Experience With Fenestrated Endovascular Compared to Open Repair of Complex Abdominal Aortic Aneurysms in a High-Volume Open Aortic Center Deery SE, Lancaster RT, Gubala AM, O’Donnell TFX, Kwolek CJ, Conrad MF, et al. Ann Vasc Surg 2018:48:151-8. Study design: Retrospective analysis of a single-center experience. Key findings: The authors identified 116 patients who underwent fenestrated endovascular aortic aneurysm repair (FEVAR; n 1⁄4 18) and open surgical repair (OSR; n 1⁄4 98) for elective complex abdominal aortic aneurysms (AAAs) between 2010 and 2015. Complex AAAs were defined as aneurysms below the diaphragm involving the renal or visceral arteries (but not type IV thoracoabdominal aortic aneurysms). FEVAR patients had higher rates of congestive heart failure than OSR patients but were otherwise well matched. There was no 30-day mortality in either group. However, hospital length of stay was shorter (2.5 vs 7.0 days) and blood loss was less (600 mL vs 1390 mL) in the FEVAR group. During average follow-up of about 2 years, FEVAR patients were significantly more likely to develop late graftrelated complications (17% vs 8.2%). Conclusion: FEVAR can be performed safely at a high-volume open aortic center with comparable perioperative risk to OSR, but FEVAR patients suffer more graft complications during follow-up. Commentary: This series is remarkable in that there were no deaths associated with open surgical repair of 98 complex AAAs. The reader should interpret these results with caution. In the current era of decreasing open aortic surgery, fewer and fewer vascular surgeons may gain the open operative experience necessary to obtain these outstanding results. Therefore, the complication rate of open surgical repair for complex AAA will almost certainly be higher at many or most other institutions than reported in this series.