Fenestrated Endografting for Aortic Aneurysm Repair: A 7-Year Experience

Abstract

Purpose:

To present a 7-year single-center clinical experience with fenestrated endografts and side branches.

Methods:

Between April 1999 and August 2006, 63 patients (57 men; mean age 70.5611.6 years, range 25–89) received custom-designed Zenith fenestrated endoprostheses for a variety of aneurysms (59 abdominal, 1 thoracoabdominal, and 3 thoracic). They were all unsuitable for standard EVAR owing to short aortic necks and high risk for open surgery.

Results:

Nineteen tube grafts and 44 composite bifurcated grafts with a total of 122 fenestrations and 58 side branches were used. Technical success was achieved in 55 (87.3%) patients and in 118 (96.7%) vessels. Treatment success was 93.7%. The mean follow-up was 23±18 months (median 14, range 6–77). Overall, 9 (7.4%) visceral branches were lost: 4 intraoperative, 2 perioperative, and 3 late. There were 12 (19.0%) endoleaks identified: 5 (7.9%: 4 type Ia and 1 fenestration-related type III) primary and 7 (11.1%: 4 type II, 1 type I, and 2 type III) secondary endoleaks; 4 resolved, 4 were treated, and 4 are under observation. At 77 months, 75.3% of patients were free of a reintervention. All reinterventions were performed within the first 14 months. Fourteen cases of renal impairment were seen [6 permanent (only 1 on dialysis) and 8 transient]. One (1.6%) conversion and 1 (1.6%) rupture were recorded; aneurysm-related mortality was 4.8% (3/63).

Conclusion:

The favorable outcomes in this study, which encompasses the team's learning curve with fenestrated endografts and side branches, support the use of these devices in selected patients.

Keywords

abdominal aortic aneurysm endovascular repair stent-graft short neck fenestrated stent-graft side branches

Get full access to this article

View all access options for this article.

References

Park

Chung

Choo

. Fenestrated stent-grafts for preserving visceral arterial branches in the treatment of abdominal aortic aneurysms: Preliminary experience. J Vasc Interv Radiol. 1996; 7: 819–823.

Faruqi

Chuter

Reilly

. Endovascular repair of abdominal aortic aneurysm using a pararenal fenestrated stent-graft. J Endovasc Surg. 1999; 6: 354–358.

Wisselink

Abruzzo

Shin

. Endoluminal repair of aneurysms containing ostia of essential branch arteries: An experimental model. J Endovasc Surg. 1999; 6: 171–179.

Browne

Hartley

Purchas

. A fenestrated covered suprarenal aortic stent. Eur J Vasc Endovasc Surg. 1999; 18: 445–449.

Carpenter

Baum

Barker

. Impact of exclusion criteria on patient selection for endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2001; 34: 1050–1054.

Semmens

Lawrence-Brown

Hartley

. Outcomes of fenestrated endografts in the treatment of abdominal aortic aneurysm in Western Australia (1997–2004). J Endovasc Ther. 2006; 13: 320–329.

O'Neill

Greenberg

Haddad

. Prospective analysis of fenestrated endovascular grafting: Intermediate-term outcomes. Eur J Vasc Endovasc Surg. 2006; 32: 115–123.

Muhs

Verhoeven

Zeebregts

. Mid-term results of endovascular aneurysm repair with branched and fenestrated endografts. J Vasc Surg. 2006; 44: 9–15.

Anderson

Berce

Hartley

. Endoluminal aortic grafting with renal and superior mesenteric artery incorporation by graft fenestration. J Endovasc Ther. 2001; 8: 3–15.

10.

Verhoeven

Prins

Tielliu

. Treatment of short-necked infrarenal aortic aneurysms with fenestrated stent-grafts: Short-term results. Eur J Vasc Endovasc Surg. 2004; 27: 477–483.

11.

Greenberg

Haulon

Lyden

. Endovascular management of juxtarenal aneurysms with fenestrated endovascular grafting. J Vasc Surg. 2004; 39: 279–287.

12.

Perdikides

Avgerinos

Lagios

. Improving endograft stability by accommodation onto the aortic bifurcation. J Endovasc Ther. 2007; 14: 000–000.

13.

White

May

. Endoleak as a complication of endoluminal grafting of abdominal aortic aneurysms: Classification, incidence, diagnosis, and management. J Endovasc Surg. 1997; 4: 152–168.

14.

Ruppert

Erz

Bürklein

. Double tube stent-grafts for infrarenal aortic aneurysm: A new concept. J Endovasc Ther. 2007; 14: 144–149.

15.

Ziegler

Perdikides

Avgerinos

. Fenestrated and branched grafts for paraanastomotic aortic aneurysm repair. J Endovasc Ther. 2007; 14: 513–519.

16.

Liffman

Lawrence-Brown

MMD

Semmens

. Analytical modeling and numerical simulation of forces in an endoluminal graft. J Endovasc Ther. 2001; 8: 358–371.

17.

Harris

Vallabhaneni

Desgranges

. Incidence and risk factors of late rupture, conversion, and death after endovascular repair of infrarenal aortic aneurysms: The EUROSTAR experience. J Vasc Surg. 2000; 32: 739–749.

18.

EVAR trial participants. Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): Randomised controlled trial. Lancet. 2005; 365(9478): 2187–2192.

19.

Blankensteijn

de Jong

Prinssen

. Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2005; 352: 2398–2405.

20.

Haddad

Greenberg

Walker

. Fenestrated endovascular grafting: The renal side of the story. J Vasc Surg. 2005; 41: 181–190.

21.

Shortell

Johansson

Green

. Optimal operative strategies in repair of juxtarenal abdominal aortic aneurysms. Ann Vasc Surg. 2003; 17: 60–65.

22.

Greenhalgh

Brown

Kwong

. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: Randomised controlled trial. Lancet. 2004; 364: 843–848.

23.

Prinssen

Verhoeven

Buth

. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2004; 351: 1607–1618.

24.

Semmens

Lawrence-Brown

Norman

. The Quality of Surgical Care Project: Benchmark standards of open resection for abdominal aortic aneurysm in Western Australia. Aust N Z J Surg. 1998; 68: 404–410.

25.

Hallet

Mills

. Treatment of renovascular disease. In: Hallet

Mills

Earnshaw

, eds. Comprehensive Vascular and Endovascular Surgery. St. Louis: Mosby; 2004: 353–355.

26.

Benjamin

Hansen

Craven

. Combined aortic and renal artery surgery. A contemporary experience. Ann Surg. 1996; 223: 555–565.