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J Endovasc Ther. 2012 Aug;19(4):528-35. doi: 10.1583/JEVT-11-3807R.1.

Fenestrated endovascular aneurysm repair: graft complexity does not predict outcome.

Author information

1
St George's Vascular Institute, St George's Healthcare NHS Trust, London, UK. mmetcalfe@doctors.org.uk

Abstract

PURPOSE:

To evaluate the outcomes of endografts designed with renal fenestrations alone vs. more complex designs that accommodate mesenteric arteries in a consecutive series of patients with pararenal aortic aneurysms undergoing endovascular aneurysm repair (EVAR).

METHODS:

A retrospective review of data prospectively collected over a 5-year period identified 42 consecutive patients (39 men; mean age 70±7 years) who had undergone fenestrated repair of 3 type IV thoracoabdominal aortic aneurysms (TAAA), 6 suprarenal aneurysms requiring at least 1 renal artery reimplantation, and 33 juxtarenal aneurysms with an infrarenal aortic neck <5 mm long. Operative variables and patient outcomes for complex fenestrated EVAR cases (n = 17) using endografts involving the renal, superior mesenteric, and/or celiac arteries were compared with fenestrated stent-grafts incorporating the renal arteries alone (n = 25). Major morbidity/mortality included death, myocardial infarction (MI), renal failure requiring dialysis, paraplegia, and bowel ischemia.

RESULTS:

Of the 95 intended target vessels, 93 (98%) were successfully cannulated and stented (mean 2.2 covered stents per patient). The 30-day mortality was 7% (n = 3), the paraplegia rate was 2% (n = 1), and MI rate was 5% (n = 2). One patient required dialysis for 3 months. Two bridging stent-grafts occluded: one immediately and another at 8 months. Complex fenestrated EVARs were associated with higher risk of major morbidity and mortality (4, 24%) compared to endografts involving the renal arteries alone (2, 8%), but this did not reach statistical significance (p = 0.20). Operation time (mean 205±50 vs. 174±48 minutes, p = 0.07), follow-up duration (mean 8.1±11 vs. 13±17 months, p = 0.29), and reintervention rates (18% vs. 24%, p = 0.72), respectively, were not significantly different between groups.

CONCLUSION:

In carefully selected patients with pararenal aneurysms, the inclusion of mesenteric arteries in the fenestrated graft design did not influence outcomes compared to fenestrated EVARs involving the renal arteries alone.

PMID:
22891836
DOI:
10.1583/JEVT-11-3807R.1
[Indexed for MEDLINE]
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