Thirty-day outcomes after fenestrated endovascular repair are superior to open repair of abdominal aortic aneurysms involving visceral vessels

Objective Although few studies have reported outcomes after branched or fenestrated endovascular aortic aneurysm repair (FEVAR) of abdominal aortic aneurysms involving visceral vessels (AAA-Vs), no multi-institutional study has compared FEVAR with open surgery (OS) for AAA-Vs. Our objective was to compare 30-day outcomes after FEVAR vs OS for AAA-Vs. Methods Patients who underwent FEVAR (n = 535) and OS (n = 1207) for elective AAA-Vs were identified from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) 2008 to 2013 database. Thoracoabdominal aneurysms were excluded. Univariable and multivariable logistic regression analyses were performed. Results There were more men (82% vs 72%; P <.0001), diabetic patients (16% vs 11%; P =.005), patients with dependent functional status (4% vs 2%; P =.002), and nonsmokers (70% vs 56%; P <.0001) in the FEVAR group vs OS. There was no difference in rates of chronic obstructive pulmonary disease, cardiac history, peripheral artery disease, hypertension, and dialysis (P >.05). FEVAR had fewer major postoperative pulmonary complications (3.0% vs 19.0%; P <.0001), less renal failure requiring dialysis (1.9% vs 6.4%; P <.0001), less frequent cardiac arrest or myocardial infarction (2.2% vs 5.8%; P =.001), less bleeding with major transfusion (17.4% vs 50.2%; P <.0001), and decreased incidence of return to the operating room (4.5% vs 9.6%; P <.0001) and death (2.4% vs 4.7%; P =.02). The median length of stay was also significantly shorter for FEVAR (2 days vs 7 days; P <.0001). On multivariable analyses, OS was associated with higher risk than FEVAR for 30-day death (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.3-5.0), pulmonary complications (OR, 8.8; 95% CI, 5.1-15.0), cardiac complications (OR, 3.4; 95% CI, 1.8-6.6), renal failure needing dialysis (OR, 3.8; 95% CI, 1.9-7.7), and return to the operating room (OR 2.5; 95% CI, 1.6-4.0). Conclusions FEVAR is associated with a lower risk for 30-day mortality and adverse events compared with OS for AAA-Vs.