Complex aortic aneurysmal disease represent around 20% of thoracic and/or abdominal aortic aneurysms. In such situations, standard endograft cannot be proposed. Fenestrated or branched EVAR (B/F-EVAR) could be a valid alternative to open surgery, requiring delay for manufacture and high technical skills. The aim of this study was to report our monocentric experience.

Retrospective analysis of prospective data retrieved from 1 center between December May 2011 and December 2021 was done. Endpoints were technical success, postoperative morbidity, rate of endoleak and any aneurysm-related re-interventions during follow-up.

In this study, 126 patients (mean age 74 years, range 47-91) were identified. They was a majority of male (81%) and all of them but 2 were asymptomatic. The mean aneurysmal diameter was 71 mm (range 52-82). There was a majority of juxtarenal (36%), Crawford type IV (27) and type II (21%) aneurysms. 130 endografts have been used with a majority of branched endografts (69%) with a mean number of fenstrations/branches per graft of 3.3. In one third of cases, the patient has been treated using a 2-steps strategy and cephalo-spinal fluid drainage was used in 65% of cases. Procedural success was achieved in 93%. There was no open conversion. The post-operative mortality rate reached 1.6%. During the post-operative period, 28% of patients presented complications with a majority of acute kidney injury. The rate of spinal cord ischemia was 7.1% and a reintervention was required in 7% of cases. During the follow-up, the Kaplan-Meier estimates of survival were 91%, 91% and 78% at 1, 3 and 5 years, respectively. The Kaplan-Meier estimates of reintervention-free survival were 84%, 70% and 61% at 1, 3 and 5 years, respectively. The target vessels patency rate was 95% and the rate of definitive paraplegia was 4.7%.

B/F-EVAR appears to be safe with good technical success for the treatment of complex aortic aneurysmal disease. It is associated with an acceptable rate of complications. Despite dedicated strategies, spinal cord ischemia remains a major complication. A close surveillance program is mandatory, as the reintervention remain high. This strategy is presents a good alternative to open surgery but should be reserved to some high-volume centers.