Mid-Term Results of an Unsupported Body Fenestrated Graft for Treating Thoracoabdominal and Suprarenal Aneurysms

Abstract

Purpose:

To evaluate the safety and efficacy of a strategy using the Anaconda Fenestrated endograft for treating thoracoabdominal aortic aneurysms (TAA) and supra-renal aortic aneurysms (SRAAs).

Methods:

Patients electively treated with the Anaconda Fenestrated endograft for an unruptured TAA or SRAA at our center between 2018 and 2023 were retrospectively analyzed. The treatment strategy included staged procedures prior to fenestrated endovascular aneurysm repair (FEVAR) and implantation of the Anaconda graft into thoracic grafts for TAA and for SRAA with an unfavorable proximal landing zone. Primary outcome was survival. Secondary outcomes included technical and early clinical success, target-vessel patency (TVP), freedom from reintervention, sac evolution, target-vessel instability (TVI), and endoleaks.

Results:

A total of 57 patients (72% male, median age 70 years) were included, comprising 32 (56.1%) SRAA and 25 (43.9%) TAA. Nineteen patients (33.3%) underwent staged procedures, and technical success was 94.7%. There were 3 (5.3%) early deaths, 1 (1.8%) permanent paraplegia, and 1 (1.8%) type IIIc endoleak, leading to an early clinical success rate of 93.0%. The mean follow-up duration was 31.6 ± 19.7 months for mortality, and 28 ± 17.0 months for other outcomes. A total of 12 (21.1%) deaths were recorded, including 4 aneurysm-related deaths, resulting in 1-year and 4-year overall survival rates of 87.7% and 78.1%, respectively. The primary TVP rate was 95.9% at 1 year and 95.2% at 5 years, while the 1-year and 3-year freedom from TVI was 84.7% and 72.2%, respectively. Seventeen patients (29.8%) required early (n=7) or late (n=14) reinterventions, resulting in 1-year and 3-year freedom from reintervention of 76.1% and 61.1%, respectively. One type 1a (1.8%), 1 type 1b (1.8%), and 5 type 3c (8.8%) endoleaks were identified and treated during follow-up. Aneurysm growth (>5 mm) was observed in 2 patients (3.8%), while sac shrinkage (>5 mm) was achieved in 29 patients (55.8%).

Conclusion:

This study demonstrates that a strategy using the Anaconda Fenestrated endograft provides acceptable efficacy and safety in the treatment of SRAA and TAA. Despite a high reintervention rate, mid-term survival, and target-vessel patency support the use of this endograft as a valid treatment option for these aneurysms.

Clinical Impact

This study reports the outcomes of 57 patients treated for suprarenal and thoracoabdominal aneurysms using the Anaconda unsupported fenestrated stent graft, combined with thoracic modules when necessary. Mid-term survival and target vessel patency were acceptable, with no indication of inferior performance compared to established platforms. While the reintervention rate warrants caution, these findings support the Anaconda fenestrated system as a potential alternative for complex aneurysms. Larger studies with extended follow-up are needed to better identify patients who may benefit from an unsupported design and to confirm its long-term durability.