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Use of Fenestrated/Branched Devices for Rescue of Proximal Endograft Failure After Endovascular Aneurysm Repair: A Systematic Review of the Literature and an Updated Meta-Analysis.

Λεπτομέρειες βιβλιογραφικής εγγραφής
Τίτλος: Use of Fenestrated/Branched Devices for Rescue of Proximal Endograft Failure After Endovascular Aneurysm Repair: A Systematic Review of the Literature and an Updated Meta-Analysis.
Συγγραφείς: Mylonas SN; Department of Vascular and Endovascular Surgery, General Hospital of Athens 'G. GENNIMATAS', Athens, Greece., Papavlasopoulos V; Department of Vascular and Endovascular Surgery, General Hospital of Athens 'G. GENNIMATAS', Athens, Greece., Moulakakis KG; Faculty of Medicine, Department of Vascular and Endovascular Surgery, University of Athens, 'Attikon' Hospital, Athens, Greece., Kakisis J; Faculty of Medicine, Department of Vascular and Endovascular Surgery, University of Athens, 'Attikon' Hospital, Athens, Greece.
Πηγή: Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists [J Endovasc Ther] 2026 Oct; Vol. 33 (5), pp. 2214-2231. Date of Electronic Publication: 2025 Mar 13.
Τύπος έκδοσης: Journal Article; Systematic Review; Meta-Analysis
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Sage Publications Country of Publication: United States NLM ID: 100896915 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1545-1550 (Electronic) Linking ISSN: 15266028 NLM ISO Abbreviation: J Endovasc Ther Subsets: MEDLINE
Imprint Name(s): Publication: 2015- : Thousand Oaks, CA : Sage Publications
Original Publication: Phoenix, AZ : The Society, c2000-
Ιατρικοί όροι (MeSH): Aortic Aneurysm, Abdominal*/surgery , Aortic Aneurysm, Abdominal*/diagnostic imaging , Aortic Aneurysm, Abdominal*/mortality , Endoleak*/mortality , Endoleak*/diagnostic imaging , Endoleak*/etiology , Endoleak*/therapy , Endoleak*/surgery , Endovascular Aneurysm Repair*/instrumentation , Endovascular Aneurysm Repair*/adverse effects , Endovascular Aneurysm Repair*/mortality , Blood Vessel Prosthesis* , Prosthesis Failure* , Stents*, Aged ; Female ; Humans ; Male ; Prosthesis Design ; Reoperation ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Failure
Περίληψη: Objective: To present the current outcomes of fenestrated and branched endovascular aneurysm repair (F/BEVAR) for rescue of proximal endograft failure after endovascular aneurysm repair (EVAR). A systematic review of the currently published literature on F/BEVAR for failed EVAR is undertaken, and the eligible studies are combined into a meta-analysis with the intention of evaluating the safety, efficacy, and the durability of this treatment option.
Materials and Methods: A systematic review of the literature up to September 2024 was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (CRD42024590847). Studies were included in the meta-analysis if they reported ≥10 patients and at least one of the major outcomes was stated. Primary endpoint was technical success (efficacy). Secondary endpoints included 30-day/in-hospital mortality and morbidity (safety) and survival and reinterventions rate (durability). Methodological quality and robustness of the results of the eligible articles were assessed according to Joanna Briggs Institute (JBI's) critical appraisal tool.
Results: A total of 16 studies with overall 1079 patients were included. The pooled estimate for technical success was 94.4% (95% CI 92.5-95.8), whereas for the 30-day/in-hospital mortality 3.9% (95% CI 2.9-5.4). Permanent paraplegia was developed in a pooled rate of 1.6% (95% CI 0.8-3.0), whereas a cerebrovascular event in a pooled rate of 1.5% (95% CI 0.9-2.8). An acute renal function impairment requiring new onset dialysis occurred with a pooled rate of 4.4% (95% CI 3.2-6.1). Postoperative respiratory failure was observed with a pooled estimate of 7.2% (95% CI 5.5-9.4). The pooled estimate for 12-month overall survival was 88% (95% CI 83.4-91.4), and the pooled estimate for 24- and 36-month survival were 79.8% (95% CI 75.6-83.4) and 72.2% (95% CI 66.7-77.2), respectively. Freedom from reintervention was estimated at 83.7% (95% CI 79.9-86.9) for 12 months, 75.8% (95% CI 61.0-86.2) for 24 months and 59.3% (95% CI 36.5-78.7) for 36 months.
Conclusion: This study showed that F/BEVAR is a feasible, safe, and reliable strategy for achieving proper proximal endograft sealing when previous EVAR has failed. The midterm survival of these patients is acceptable, whereas reinterventions are not negligible.Clinical ImpactThis work summarizes the current experience with fenestrated and branched endovascular aneurysm repair for the rescue of failed endovascular aneurysm repair in the most contemporary meta-analysis including 16 studies with a total of 1079 analyzed patients. Feasibility of the method is proven with a technical success of 94.4%, whereas a 30-day/in-hospital mortality of 3.9% was recorded. The compromised survival and freedom from reinterventions rates (72.2% and 59.3% for 36 months, respectively) pose, however, concerns regarding durability of the method.
Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Contributed Indexing: Keywords: branched; endoleak type Ia; endovascular aneurysm repair; fenestrated; mortality; physician modified; stent-graft
Entry Date(s): Date Created: 20250313 Date Completed: 20260916 Latest Revision: 20260922
Update Code: 20260922
DOI: 10.1177/15266028251325430
PMID: 40079708
Βάση Δεδομένων: MEDLINE
FullText Text:
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PubType: Academic Journal
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  Data: Use of Fenestrated/Branched Devices for Rescue of Proximal Endograft Failure After Endovascular Aneurysm Repair: A Systematic Review of the Literature and an Updated Meta-Analysis.
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  Data: <searchLink fieldCode="AU" term="%22Mylonas+SN%22">Mylonas SN</searchLink>; Department of Vascular and Endovascular Surgery, General Hospital of Athens 'G. GENNIMATAS', Athens, Greece.<br /><searchLink fieldCode="AU" term="%22Papavlasopoulos+V%22">Papavlasopoulos V</searchLink>; Department of Vascular and Endovascular Surgery, General Hospital of Athens 'G. GENNIMATAS', Athens, Greece.<br /><searchLink fieldCode="AU" term="%22Moulakakis+KG%22">Moulakakis KG</searchLink>; Faculty of Medicine, Department of Vascular and Endovascular Surgery, University of Athens, 'Attikon' Hospital, Athens, Greece.<br /><searchLink fieldCode="AU" term="%22Kakisis+J%22">Kakisis J</searchLink>; Faculty of Medicine, Department of Vascular and Endovascular Surgery, University of Athens, 'Attikon' Hospital, Athens, Greece.
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  Data: <searchLink fieldCode="JN" term="%22100896915%22">Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists</searchLink> [J Endovasc Ther] 2026 Oct; Vol. 33 (5), pp. 2214-2231. <i>Date of Electronic Publication: </i>2025 Mar 13.
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  Data: Journal Article; Systematic Review; Meta-Analysis
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  Data: <i>Publisher: </i><searchLink fieldCode="PB" term="%22Sage+Publications%22">Sage Publications </searchLink><i>Country of Publication: </i>United States <i>NLM ID: </i>100896915 <i>Publication Model: </i>Print-Electronic <i>Cited Medium: </i>Internet <i>ISSN: </i>1545-1550 (Electronic) <i>Linking ISSN: </i><searchLink fieldCode="IS" term="%2215266028%22">15266028 </searchLink><i>NLM ISO Abbreviation: </i>J Endovasc Ther <i>Subsets: </i>MEDLINE
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  Data: <i>Publication</i>: 2015- : Thousand Oaks, CA : Sage Publications<br /><i>Original Publication</i>: Phoenix, AZ : The Society, c2000-
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  Data: <searchLink fieldCode="MM" term="%22Aortic+Aneurysm%2C+Abdominal%22">Aortic Aneurysm, Abdominal*</searchLink>/<searchLink fieldCode="MM" term="%22Aortic+Aneurysm%2C+Abdominal+surgery%22">surgery</searchLink> <br /><searchLink fieldCode="MM" term="%22Aortic+Aneurysm%2C+Abdominal%22">Aortic Aneurysm, Abdominal*</searchLink>/<searchLink fieldCode="MM" term="%22Aortic+Aneurysm%2C+Abdominal+diagnostic+imaging%22">diagnostic imaging</searchLink> <br /><searchLink fieldCode="MM" term="%22Aortic+Aneurysm%2C+Abdominal%22">Aortic Aneurysm, Abdominal*</searchLink>/<searchLink fieldCode="MM" term="%22Aortic+Aneurysm%2C+Abdominal+mortality%22">mortality</searchLink> <br /><searchLink fieldCode="MM" term="%22Endoleak%22">Endoleak*</searchLink>/<searchLink fieldCode="MM" term="%22Endoleak+mortality%22">mortality</searchLink> <br /><searchLink fieldCode="MM" term="%22Endoleak%22">Endoleak*</searchLink>/<searchLink fieldCode="MM" term="%22Endoleak+diagnostic+imaging%22">diagnostic imaging</searchLink> <br /><searchLink fieldCode="MM" term="%22Endoleak%22">Endoleak*</searchLink>/<searchLink fieldCode="MM" term="%22Endoleak+etiology%22">etiology</searchLink> <br /><searchLink fieldCode="MM" term="%22Endoleak%22">Endoleak*</searchLink>/<searchLink fieldCode="MM" term="%22Endoleak+therapy%22">therapy</searchLink> <br /><searchLink fieldCode="MM" term="%22Endoleak%22">Endoleak*</searchLink>/<searchLink fieldCode="MM" term="%22Endoleak+surgery%22">surgery</searchLink> <br /><searchLink fieldCode="MM" term="%22Endovascular+Aneurysm+Repair%22">Endovascular Aneurysm Repair*</searchLink>/<searchLink fieldCode="MM" term="%22Endovascular+Aneurysm+Repair+instrumentation%22">instrumentation</searchLink> <br /><searchLink fieldCode="MM" term="%22Endovascular+Aneurysm+Repair%22">Endovascular Aneurysm Repair*</searchLink>/<searchLink fieldCode="MM" term="%22Endovascular+Aneurysm+Repair+adverse+effects%22">adverse effects</searchLink> <br /><searchLink fieldCode="MM" term="%22Endovascular+Aneurysm+Repair%22">Endovascular Aneurysm Repair*</searchLink>/<searchLink fieldCode="MM" term="%22Endovascular+Aneurysm+Repair+mortality%22">mortality</searchLink> <br /><searchLink fieldCode="MM" term="%22Blood+Vessel+Prosthesis%22">Blood Vessel Prosthesis*</searchLink> <br /><searchLink fieldCode="MM" term="%22Prosthesis+Failure%22">Prosthesis Failure*</searchLink> <br /><searchLink fieldCode="MM" term="%22Stents%22">Stents*</searchLink><br /><searchLink fieldCode="MH" term="%22Aged%22">Aged</searchLink> ; <searchLink fieldCode="MH" term="%22Female%22">Female</searchLink> ; <searchLink fieldCode="MH" term="%22Humans%22">Humans</searchLink> ; <searchLink fieldCode="MH" term="%22Male%22">Male</searchLink> ; <searchLink fieldCode="MH" term="%22Prosthesis+Design%22">Prosthesis Design</searchLink> ; <searchLink fieldCode="MH" term="%22Reoperation%22">Reoperation</searchLink> ; <searchLink fieldCode="MH" term="%22Risk+Assessment%22">Risk Assessment</searchLink> ; <searchLink fieldCode="MH" term="%22Risk+Factors%22">Risk Factors</searchLink> ; <searchLink fieldCode="MH" term="%22Time+Factors%22">Time Factors</searchLink> ; <searchLink fieldCode="MH" term="%22Treatment+Failure%22">Treatment Failure</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: To present the current outcomes of fenestrated and branched endovascular aneurysm repair (F/BEVAR) for rescue of proximal endograft failure after endovascular aneurysm repair (EVAR). A systematic review of the currently published literature on F/BEVAR for failed EVAR is undertaken, and the eligible studies are combined into a meta-analysis with the intention of evaluating the safety, efficacy, and the durability of this treatment option.<br />Materials and Methods: A systematic review of the literature up to September 2024 was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (CRD42024590847). Studies were included in the meta-analysis if they reported ≥10 patients and at least one of the major outcomes was stated. Primary endpoint was technical success (efficacy). Secondary endpoints included 30-day/in-hospital mortality and morbidity (safety) and survival and reinterventions rate (durability). Methodological quality and robustness of the results of the eligible articles were assessed according to Joanna Briggs Institute (JBI's) critical appraisal tool.<br />Results: A total of 16 studies with overall 1079 patients were included. The pooled estimate for technical success was 94.4% (95% CI 92.5-95.8), whereas for the 30-day/in-hospital mortality 3.9% (95% CI 2.9-5.4). Permanent paraplegia was developed in a pooled rate of 1.6% (95% CI 0.8-3.0), whereas a cerebrovascular event in a pooled rate of 1.5% (95% CI 0.9-2.8). An acute renal function impairment requiring new onset dialysis occurred with a pooled rate of 4.4% (95% CI 3.2-6.1). Postoperative respiratory failure was observed with a pooled estimate of 7.2% (95% CI 5.5-9.4). The pooled estimate for 12-month overall survival was 88% (95% CI 83.4-91.4), and the pooled estimate for 24- and 36-month survival were 79.8% (95% CI 75.6-83.4) and 72.2% (95% CI 66.7-77.2), respectively. Freedom from reintervention was estimated at 83.7% (95% CI 79.9-86.9) for 12 months, 75.8% (95% CI 61.0-86.2) for 24 months and 59.3% (95% CI 36.5-78.7) for 36 months.<br />Conclusion: This study showed that F/BEVAR is a feasible, safe, and reliable strategy for achieving proper proximal endograft sealing when previous EVAR has failed. The midterm survival of these patients is acceptable, whereas reinterventions are not negligible.Clinical ImpactThis work summarizes the current experience with fenestrated and branched endovascular aneurysm repair for the rescue of failed endovascular aneurysm repair in the most contemporary meta-analysis including 16 studies with a total of 1079 analyzed patients. Feasibility of the method is proven with a technical success of 94.4%, whereas a 30-day/in-hospital mortality of 3.9% was recorded. The compromised survival and freedom from reinterventions rates (72.2% and 59.3% for 36 months, respectively) pose, however, concerns regarding durability of the method.
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  Data: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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  Data: <i>Keywords: </i>branched; endoleak type Ia; endovascular aneurysm repair; fenestrated; mortality; physician modified; stent-graft
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  Data: <i>Date Created: </i>20250313 <i>Date Completed: </i>20260916 <i>Latest Revision: </i>20260922
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        Text: English
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      – TitleFull: Use of Fenestrated/Branched Devices for Rescue of Proximal Endograft Failure After Endovascular Aneurysm Repair: A Systematic Review of the Literature and an Updated Meta-Analysis.
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