Zlatanovic, Petar (57201473730)Petar (57201473730)ZlatanovicJovanovic, Aleksa (57216047949)Aleksa (57216047949)JovanovicTripodi, Paolo (57191963001)Paolo (57191963001)TripodiDavidovic, Lazar (7006821504)Lazar (7006821504)Davidovic2025-06-122025-06-122022https://doi.org/10.3390/jcm11226779https://www.scopus.com/inward/record.uri?eid=2-s2.0-85142392933&doi=10.3390%2fjcm11226779&partnerID=40&md5=c9198f29af8fbccdd31af061db501a9ehttps://remedy.med.bg.ac.rs/handle/123456789/3154Introduction: This systematic review with network meta-analysis aimed at comparing the medium-term results of open surgery (OS), fenestrated endovascular repair (FEVAR), and chimney endovascular repair (ChEVAR) in patients with juxta/pararenal abdominal aortic aneurysms (JAAAs/PAAAs). Materials and methods: MEDLINE, SCOPUS, and Web of Science were searched from inception date to 1st July 2022. Any studies comparing the results of two or three treatment strategies (ChEVAR, FEVAR, or OS) on medium-term outcomes in patients with JAAAs/PAAAs were included. Primary outcomes were all-cause mortality, aortic-related reintervention, and aortic-related mortality, while secondary outcomes were visceral stent/bypass occlusion/occlusion, major adverse cardiovascular events (MACEs), new onset renal replacement therapy (RRT), total endoleaks, and type I/III endoleak. Results: FEVAR (OR = 1.53, 95%CrI 1.03–2.11) was associated with higher medium-term all-cause mortality than OS. Sensitivity analysis including only studies that analysed JAAA showed that FEVAR (OR = 1.65, 95%CrI 1.08–2.33) persisted to be associated with higher medium-term mortality than OS. Both FEVAR (OR = 8.32, 95%CrI 3.80–27.16) and ChEVAR (OR = 5.95, 95%CrI 2.23–20.18) were associated with a higher aortic-related reintervention rate than OS. No difference between different treatment options was found in terms of aortic-related mortality. FEVAR (OR = 13.13, 95%CrI 2.70–105.2) and ChEVAR (OR = 16.82, 95%CrI 2.79–176.7) were associated with a higher rate of medium-term visceral branch occlusion/stenosis compared to OS; however, there was no difference found between FEVAR and ChEVAR. Conclusions: An advantage of OS compared to FEVAR and ChEVAR after mid-term follow-up aortic-related intervention and vessel branch/bypass stenosis/occlusion was found. This suggests that younger, low-surgical-risk patients might benefit from open surgery of JAAA/PAAA as a first approach. © 2022 by the authors.abdominal aortic aneurysm (AAA)chimney EVAR (ChEVAR)endovascular aneurysm repair (EVAR)fenestrated EVAR (FEVAR)juxtarenalmedium-termopen surgerypararenal