{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,21]],"date-time":"2026-06-21T04:48:28Z","timestamp":1782017308301,"version":"3.54.5"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T00:00:00Z","timestamp":1694563200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Aim<\/jats:title><jats:p>Early\/follow-up durability of superior mesenteric artery (SMA) stent-grafts is crucial after fenestrated\/branched endografting (FB-EVAR) in complex abdominal aortic aneurysms (CAAAs) and thoracoabdominal aortic aneurysms (TAAAs). The study aimed to report early\/midterm outcomes of SMA incorporated during FB-EVAR procedures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>FB-EVAR procedures performed between 2016 and 2021 in a single institution were reviewed. Anatomical SMA characteristics were analyzed. The SMA configuration was classified into three types according to the angle between the SMA main trunk and the aorta: (A) perpendicular, (B) downward, and (C) upward. SMA-related technical success (SMA-TS: cannulation and stenting, patency at completion angiography without endoleak, stenosis\/kinking, dissection, bleeding, and 24-h mortality) and SMA-adverse events (SMA-AEs: one among bowel ischemia, stenosis, occlusion, endoleak, reinterventions, or SMA-related mortality) were assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Two hundred FB-EVAR procedures with SMA as the target artery were performed. The indication for FB-EVAR was CAAAs and TAAAs in 99 (49%) and 101 (51%) cases, respectively. The SMA configuration was A, B, and C in 132 (66%), 63 (31%), and 5 (3%) cases, respectively. SMA was incorporated with fenestrations and branches in 131 (66%) and 69 (34%) cases, respectively. Directional branch (<jats:italic>P<\/jats:italic>\u2009&amp;lt;\u2009.001), aortic diameter \u226535\u2005mm at the SMA level (<jats:italic>P<\/jats:italic>\u2009&amp;lt;\u2009.001), and \u22652 SMA bridging stent-grafts (<jats:italic>P<\/jats:italic>\u2009=\u2009.001) were more frequent in TAAAs. Relining of the SMA stent-graft with a bare metal stent was necessary in 41 (21%) cases to correct an acute angle between the stent-graft and native artery (39), stent-graft stenosis (1), or SMA dissection (1). Relining was associated with type A or C SMA configuration (OR: 17; 95% CI: 1.8\u2013157.3; <jats:italic>P<\/jats:italic>\u2009=\u2009.01). SMA-TS was achieved in all cases. Overall, 15 (7.5%) patients had SMA-AEs [early: 9 (60%), follow-up: 6 (40%)] due to stenosis (2), endoleak (8), and bowel ischemia (5). Aortic diameter \u226535\u2005mm at the SMA level was an independent risk factor for SMA-AEs (OR: 4; 95% CI: 1.4\u201313.8; <jats:italic>P<\/jats:italic>\u2009=\u2009.01). Fourteen (7%) patients died during hospitalization with 10 (5%) events within the 30-postoperative day. Emergency cases (OR: 33; 95% CI: 5.7\u2013191.3; <jats:italic>P<\/jats:italic>\u2009=\u2009.001), peripheral arterial occlusive disease (OR: 14; 95% CI: 2.3\u201388.8; <jats:italic>P<\/jats:italic>\u2009=\u2009.004), and bowel ischemia (OR: 41; 95% CI: 1.9\u201387.9; <jats:italic>P<\/jats:italic>\u2009=\u2009.01) were risk factors for 30-day\/in-hospital mortality. The mean follow-up was 32\u2009\u00b1\u200924 months; estimated 3-year survival was 81%, with no case of late SMA-related mortality or occlusion. The estimated 3-year freedom from overall and SMA-related reinterventions was 74% and 95%, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>SMA orientation determines the necessity of stent-graft relining. Aortic diameter \u226535\u2005mm at the SMA level is a predictor of SMA-AEs. Nevertheless, SMA-related outcomes of FB-EVAR are satisfactory, with excellent technical success and promising clinical outcomes during the follow-up.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2023.1252533","type":"journal-article","created":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T16:34:33Z","timestamp":1694622873000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Superior mesenteric artery-related outcomes in fenestrated\/branched endografting for complex aortic 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