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J Vasc Surg. 2014 Mar;59(3):615-22. doi: 10.1016/j.jvs.2013.10.038. Epub 2013 Dec 15.

Experience with a novel custom-made fenestrated stent graft in the repair of juxtarenal and type IV thoracoabdominal aneurysms.

Author information

1
Imperial Vascular Unit, Imperial College Healthcare National Health Service Trust, London, United Kingdom. Electronic address: alex.rolls1981@googlemail.com.
2
Imperial Vascular Unit, Imperial College Healthcare National Health Service Trust, London, United Kingdom.
3
Department of Interventional Radiology, Imperial College Healthcare National Health Service Trust, London, United Kingdom.

Abstract

OBJECTIVE:

Fenestrated stent grafting has become increasingly popular as a means to manage complex aortic pathology, including juxta- and pararenal aneurysms. The design of a recently developed custom-made fenestrated stent graft, in theory, confers advantages when managing anatomically challenging aortic morphology. This study evaluated its feasibility in anatomically challenging scenarios.

METHODS:

Over a 12-month period, 20 patients received fenestrated stent grafts. Among those, 13 patients with juxtarenal or type IV thoracoabdominal aortic aneurysms underwent endovascular repair with the novel fenestrated stent graft at a single UK institution. Data on aneurysm morphology and immediate and short-term results were collected prospectively.

RESULTS:

The mean aneurysmal sac size was 7.3 cm (range, 5.5-10.0 cm). The mean infrarenal neck length was 4.4 mm (range, 0-9 mm), and in three cases was lined by a pre-existing infrarenal stent graft. Nine cases had an infrarenal neck angulation of 60(°) or more in either the anteroposterior or coronal planes. Five cases had ≥50% thrombus at the proximal landing zone. A total of 35 target vessels were cannulated, of which six right renal and four left renal arteries were angulated ≥120(°). Two-thirds of cannulated celiac trunks were angulated ≥120(°), and one cannulated superior mesenteric artery was angulated ≥ 140(°). Seven of the cannulated targets were stenosed more than 60%. One patient had two right renal arteries arising 3 mm from each other. Four right and four left common iliac arteries were angulated ≥90(°) in relation to the infrarenal aorta. Technical success was 100%. Median time from date of procedure to most recent follow-up with computed tomography scanning was 33 weeks. There was no type I or III endoleak. One type II endoleak was observed at the time of most recent computed tomography scanning and treated expectantly. There was a single incident of left renal artery occlusion. One patient required repair of a brachial artery, fasciotomies, and temporary haemofiltration. One patient died from ischemic heart disease 77 weeks after the procedure.

CONCLUSIONS:

The use of the novel fenestrated stent graft system in patients with hostile aortic aneurysmal morphology is feasible with acceptable short-term outcomes.

PMID:
24342068
DOI:
10.1016/j.jvs.2013.10.038
[Indexed for MEDLINE]
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