SRS222 - Long-term outcomes and durability of fenestrated endovascular aneurysm repair (FEVAR): results from the UK GLOBALSTAR registry

Abstract Introduction GLOBALSTAR is a registry of 1587 FEVAR cases from 15 UK centres (2003–2022), established by BSET. Aims were to report long-term outcomes for FEVAR. Methods Study design: retrospective cohort study of GLOBALSTAR. Inclusion criteria: aneurysmal pathology and custom-made FEVAR alone. Data were collected according to a standardised protocol. Time-to-event analyses were conducted for all-cause survival, aneurysm-related mortality and re-intervention. Log-rank sub-analyses were conducted for octogenarians and sexes. Results 1587 patients across 15 centres were included. Median age = 75 years [69–79,IQR] and male = 87.9%. Patients were co-morbid with 45.0% IHD and 73.3% hypertension. All-cause survival at 3, 5 and 10 years was 79.5% [95% c.i., 77.6–81.6%], 64.2% [61.8–66.7%] and 30.3% [27.4–33.4%] with median survival = 6.9 years [6.6–7.2]. Aneurysm-related mortality cumulative incidence = 6.7% at 10 years [5.4–8.1%]. Secondary sac rupture was rare with 4.0 events/1000 patient-years. Cumulative incidence of re-intervention at 3, 5 and 8 years was 20.2% [18.2–22.3%], 24.4% [22.2–26.7%] and 27.7% [25.3–30.2%]. Graft-related complications accounted for 73.8% of re-interventions. Women had significantly worse 2-year survival (80.4%, [75.0- 86.3%]) than men (86.4%, [84.6–88.3%]) (P < 0.05), driven by peri-operative mortality. Beyond 2 years, differences in survival were not significant. Octogenarians had equivalent survival (89.6% [86.5–92.7%]) to non-octogenarians (92.2% [90.7–93.7%]) up to 1 year (P = 0.098). Beyond 1 year, survival differences were significant. Octogenarians' median survival = 5.4 years [5.0–6.1]. Conclusions Long-term outcomes for FEVAR appear acceptable, with low rates of secondary sac rupture. FEVAR carries risk, especially of re-intervention- driven by graft-related complications, highlighting the importance of surveillance. Peri-operative mortality was significantly higher in women, warranting further investigation.