Propensity Score Matched Comparison of EndoSuture versus Fenestrated Aortic Aneurysm Repair in Treatment of Abdominal Aortic Aneurysms with Unfavorable Neck Anatomy

Hostile aortic neck anatomy is associated with loss of proximal seal and increased late reinterventions. While both EndoSuture aneurysm repair (ESAR) and fenestrated endovascular aortic repair (FEVAR) are commercially available options for treatment of short-neck aneurysms, branch vessel patency is a potential tradeoff for improved seal with FEVAR due to incorporation of renovisceral vessels. This study compares the performance of ESAR versus FEVAR in hostile aortic necks. Patients who underwent elective ESAR or FEVAR for hostile neck AAAs at a single center from 2012-2024 were retrospectively reviewed. Exclusion criteria included pararenal or thoracoabdominal aortic aneurysm, off-label modifications, and non-standard FEVAR configurations. Propensity matching weights were generated based on age, year of operation, pre-operative eGFR, neck length, neck diameter and infrarenal angulation. Rates of survival, reintervention, dialysis, CKD stage progression, type IA endoleak (EL), and sac regression (>5mm) were assessed at latest follow-up. Of 391 patients, 60 with ESAR and 207 with FEVAR were included. FEVAR patients were younger (74.4 vs 79.8; P