On Tuesday, Krassi Ivancev, London, UK, persuaded 62% of the CX audience to support the motion that fenestrated and branched EVAR are worthwhile. In opposing the motion, Jean-Pierre Becquemin, Creteil, France, garnered the remainder (32%).

He told delegates it was important to clarify the terminology: fenestrated stent grafts were used in juxtarenal abdominal aortic aneurysms or pararenal abdominal aortic aneurysms; fenestrated or branched stent grafts were used in suprarenal or thoracic abdominal aortic aneurysms (type IV); and branched stent grafts are used in thoracoabdominal aortic aneurysms. Ivancev said the results of open repair in such aneurysms were associated with a high mortality rate.

Ivancev based his argument on the fact that the results for open surgical repair were unlikely to improve, and that EVAR was a proven concept. “Fenestrated and branched stent grafts results are equal or superior to the results with open repair,” he said.

He admitted that there was not much long-term data for fenestrated and branched EVAR, but emphasised  that the mortality from the procedure was nowhere near that of open repair.

“Patients who are unfit for open repair have been treated successfully. Cost-effectiveness of the procedures, comes with skills, the more you learn to do the better you do it,” he said.

Becquemin noted that fenestrated and branched grafts were like “haute couture, very beautiful, but very expensive”.

He told delegates that in order to be considered worthwhile, fenestrated and branched endografts needed to beapplicable to the majority of patients and that patients had to have no other alternative techniques available to them. “Fenestrated and branched grafts should have a reduced mortality and morbidity compared to open surgery, have proven long-term efficiency and be cost-effective. However, none of these prerequisites are fulfilled,” he said.

While he conceded that the mortality with fenestrated and branched endografts was low, he noted that they were associated with a fairly high rate of paraplegia and re-interventions. “There are no data so far to show any proven long-term benefit of fenestrated and branched EVAR,” he said.