The use of combined fenestrated and bifurcated endografts in fenestrated aortic repair

Background: The aim of this study was to compare the use of combined fenestrated and bifurcated aortic endografts to the standard modular design including a proximal fenestrated and a distal, bifurcated endograft. The combined design allows for a modification of the procedure that may contribute to lower the risk of damaging the target vessel stents and to reduce the perioperative obstruction of the ipsilateral access vessel. Methods: Consecutive patients treated with fenestrated aortic repair between December 2020 and December 2022 were included in this retrospective, single center study. Technical success was analyzed, including the integrity of the target vessel (TV) stents assessed on perioperative CT. Further, the duration during which the large introducer had to be kept in the access vessel was analyzed. Finally, we report technical data on the endograft design, adverse events and midterm results. Results: Twelve patients were treated with a modular endograft (group A) and 13 patients with a combined endograft design (group B). Technical success was 100% in both groups, however there were 4 deformed target vessel stents in group A, none in group B. The duration of potential flow reduction due to a large introducer in the access vessel was significantly shorter in group B than group A (median 54 minutes vs. 109.5 minutes, p<0.05). No adverse events were reported in any of the groups. The observation period was shorter in group B (median 18 months vs. 33 months, p<0.05). Except one case of aneurysm growth in group A, all other patients in both groups showed stable or decreased aneurysm size without TV occlusions. Conclusions: The integration of the bifurcation on the fenestrated endograft may contribute to the prevention of damage of the TV stents and has a potential to reduce the duration of perioperative limb obstruction.