UC San Diego

BACKGROUND: Fenestrated/branched endovascular aortic repair (F/BEVAR) with commercially available devices require a paravisceral segment >20 mm. We compared commercial and physician-modified F/BEVAR outcomes in a narrowed flow lumen (NFL, <20 mm) to a standard flow lumen (SFL, ≥20 mm). METHODS: We conducted a retrospective review of F/BEVAR repairs between 2016 and 2024. Primary outcome was technical success, and secondary endpoints were target vessel stability, type 1/3 endoleaks requiring reintervention, and major adverse events (MAEs). RESULTS: A total of 136 patients underwent 138 repairs (75% male, 74 ± 10 years), 35 repairs (25%) were in NFL and 103 (75%) in SFL. Median visceral segment diameter was 24 mm (interquartile range [IQR] 19-29; 16 mm, IQR 15-18 in NFL; 28 mm, IQR 23-30 in SFL, P < 0.001). We observed 99% technical success. Mean fenestrations per repair was higher in NFL (3.1 vs. 1.5, P < 0.001), and mean branches was higher in SFL (2.1 vs. 0.7, P < 0.001). There were 24 (17%; 2 in NFL, 22 in SFL, P = 0.035) MAEs. There were nine branch vessel occlusions (three in NFL, six in SFL, P = 0.463) at a median follow-up of 516 days. Target vessel stability (86% in NFL vs. 84% in SFL, P = 0.757) and rate of reinterventions (2, 6% in NFL; 14, 14% in SFL, P = 0.209) did not differ significantly. CONCLUSION: Custom F/BEVAR offers equivalent outcomes in complex anatomy with narrowed paravisceral flow lumens compared to on-label branched and fenestrated repairs in SFLs. Early results demonstrate reasonable target vessel stability and freedom from reintervention, though additional follow-up is needed.