Mid-term Outcomes of Four-Fenestrated Endovascular Aneurysm Repair Without Stenting of the Celiac Artery (The UNCAP Study): Insights From a Multicentric European Experience

Abstract

Objectives:

This study analyses the results of endovascular treatment of juxtarenal and suprarenal aortic aneurysms (J/SAAAs) using fenestrated stent-grafts with 4 fenestrations (4×FEVAR) in which the celiac artery (CA) was left unstented.

Methods:

Retrospective multicentre study of all consecutive patients treated between May 2018 and January 2024 at 4 European aortic centres. Patients undergoing 4×FEVAR for a J/SAAA in which the fenestration for the CA was left unstented were included. The primary outcomes were primary patency of the CA and CA-related endoleaks, reinterventions and target vessel instability.

Results:

68 patients (64 males; mean age 73±7 years) were included. Sixty-two (91%) patients were preoperatively planned to leave the CA unstented. In the remaining six (9%) there was a failure to catheterize the vessel or advance the introducer. There was no CA-related endoleak or occlusion in any patient in the completion angiography. During a median follow-up of 27 months (interquartile range 17–54), a CA-related endoleak was detected in one (1.5%) patient that required reintervention and stenting 2 years after the index procedure. Three (4%) patients presented with an asymptomatic occlusion at 6, 12 and 13 months after surgery, which were treated conservatively. Estimated CA-primary patency at 1, 2 and 3 years was 98.4±1.6%, 94.8±2.9% and 94.8±2.9%, respectively. Two (3%) patients underwent a reintervention involving the CA: the patient with the CA-related endoleak and one patient with thoracic stent-graft extension and stenting of the CA due to proximal progression of disease. Estimated freedom from target vessel instability at 1, 2 and 3 years was 98.4±1.6%, 92.2±3.8% and 92.2±3.8%, respectively.

Conclusions:

Endovascular repair with 4×FEVAR without stenting of the CA appears to be a safe and effective strategy to treat J/SAAA in selected patients with adequate sealing in the visceral aorta.

Clinical Impact

This study analyses the outcomes of endovascular treatment of juxtarenal/suprarenal aneurysms (J/SAAA) using fenestrated stent-grafts with 4 fenestrations (4xFEVAR) in which the fenestration for the celiac artery (CA) was left unstented. This approach can decrease the complexity and duration of 4xFEVAR procedures virtually converting them to simpler 3xFEVAR procedures, while adding proximal sealing length and potentially facilitating a proximal extension of the endovascular repair. The outcomes of this multicentre study suggest that this strategy can be a safe and effective option to treat J/SAAA with adequate sealing in the visceral aorta.