Original title: Comparison of fenestrated endovascular and open repair of abdominal aortic aneurysms not suitable for standard endovascular repair. Reference: Rana Canavati et al. J Vasc Surg 2013;57:362-7.
Studies in patients with infrarenal abdominal aortic aneurysm that could receive a standard stent versus conventional surgery, showed reduced perioperative mortality with endovascular treatment.
However, these same results in patients with unsuitable necks for standard treatment (pararenal aneurysms or juxtarenal) requiring a fenestrated stent, are unclear. All 107 patients with abdominal aortic aneurysm and unsuitable neck for standard therapy, were eligible for the study, of whom 54 received surgery and 53 patients, fenestrated endograft (Zenith fenestrated stentgraft Cook UK Ltd, Hitchin, UK).
In the postoperative 30 patients, (56%) in the surgical group and 18 patients (34%) in the endovascular group, presented complications. This difference in favor of endovascular treatment was significant (p = 0.045) as well as the total number of early reoperation (p = 0.04) and hospital stay (mean 12 days for surgery versus 7 days for endovascular, P = 0.0001). At 30-days, mortality was 9.2% (5 patients) for the surgical group and 3.7% (2 patients) for the endovascular group.
Conclusion:
This single-center analysis showed that fenestrated endovascular stenting treatment, is associated with a reduction in mortality, morbidity and hospital stay, compared with surgery in patients with abdominal aortic aneurysm with unsuitable neck.
Commentary:
With several methodological limitations, this study is hypothesis-generating to perform prospective and randomized jobs. An example of this, is that in almost half of patients in the surgical group, it was not technically possible the fenestrated prosthesis implantation, these patients were operated because it was their only option. Similarly in the endovascular group, many surgical patients were discarded by severe multiple comorbidities. The cohorts were different in many ways, so the results should be interpreted in this context.
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