Cost-utility Analysis of Fenestrated Aortic Stents Versus Open Surgery for the Treatment of Complex Abdominal Aortic Aneurysms

Inclusion criteria

• Presence of an abdominal aortic aneurysm greater than 50 mm in diameter, anatomically unsuitable for a standard infrarenal stent graft because of an inadequate infrarenal neck and for which a treatment by FEVAR or OR is considered. The AAA can be identified as follows, according to preoperative imaging:

• Short-neck or juxtarenal aneurysm: if treated by OR, would require an infrarenal proximal aortic suture, regardless of the level of clamping.
• Suprarenal aneurysm: if treated by OR, would require a suprarenal/supramesenteric/ supraceliac aortic cross clamping, and a proximal bevelled suture and/or a separate revascularization of at least one renal artery.
• Type IV thoracoabdominal aneurysm: aneurysm extending up to the level of the diaphragm pillars, requiring a supracoeliac clamping with a proximal bevelled suture and/or separate revascularization of at least one renal artery if treated by open surgery.
• Patients aged 18 and over
• Patient who expressed a non-opposition to participating in the study.
• Patient affiliated to the French healyh care system

Exclusion criteria

• Presence of a type I, II, III or V thoracoabdominal aneurysm according to the modified Crawford Classification.
• Patients for whom an alternative surgical technique is being considered and listes below: laparoscopic aortic repair, hybrid repair, CHIMPS, surgeon modified stent grafting, in situ fenestrations.
• Patients deemed at prohibitive risk for OR :

• uncompensated cardiac failure with LVEF <40% (NYHA class III and IV)
• Coronary revascularization < 1 month
• Large myocardial ischemia >3 segments not revascularized or not revascularizable
• Non-revascularized or non-revascularizable unstable angina
• Non-operable tight aortic stenosis (mean gradient > 40 mmHg, valve area < 1 cm2, peak transvalvular velocity > 4 m/s)
• Non operable significant mitral shrinkage (area <1.5cm²)
• FEV1 < 50% of the theoretical value
• Home oxygen therapy
• Chronic renal failure with clearance < 30 ml/min
• presence of a main renal artery less than 4 mm in diameter
• Special anatomical configurations: horseshoe kidney, pelvic kidney.
• Lesions of "shaggy" aorta at the visceral segment or at the lower thoracic aorta
• History of abdominal aortic surgery (open or endovascular)
• Dissecting, infected, ruptured or painful aneurysm
• Life expectancy less than 2 years
• Person under judicial protection
• Person under tutorship or curatorship
• Pregnant or breastfeeding woman