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J Vasc Surg. 2016 Sep;64(3):692-7. doi: 10.1016/j.jvs.2016.02.031. Epub 2016 Jun 8.

Superior mesenteric artery outcomes after fenestrated endovascular aortic aneurysm repair.

Author information

1
Division of Vascular Surgery, University of Texas Southwestern Medical Center, Dallas, Tex. Electronic address: salimlala1@gmail.com.
2
Division of Vascular Surgery, University of North Carolina, Chapel Hill, NC.
3
Division of Vascular Surgery, University of Texas Southwestern Medical Center, Dallas, Tex.
4
Division of Vascular Surgery, Baylor University Medical Center, Dallas, Tex.
5
Division of Vascular Surgery, Vanderbilt University, Nashville, Tenn.

Abstract

OBJECTIVE:

The Zenith (Cook Medical, Bloomington, Ind) fenestrated endovascular graft may be designed with single-wide scallops or large fenestrations to address the superior mesenteric artery (SMA). Misalignment of the SMA with an unstented scallop or a large fenestration is possible. This study assessed SMA outcomes after fenestrated endovascular aortic aneurysm repair (FEVAR).

METHODS:

During an 18-month period, 47 FEVARs were performed at a single institution. For analysis, patients were grouped according to unstented (n = 23) vs stented (n = 24) SMA scallops/fenestrations. The Institutional Review Board approved this single-institution observational study. Because this was a retrospective review of the data, patient consent was unnecessary for the study.

RESULTS:

Technical success for FEVAR was 100%. The median follow-up period was 7.7 months (range, 1-16 months). Nine of 21 patients (43%) in the unstented group had some degree of misalignment of the SMA (range, 9%-71%). Among these, four patients (44%) developed complications: three SMA stenoses and one occlusion. The mean peak systolic velocity in patients with and without SMA misalignment was 317.8 cm/s vs 188.4 cm/s (P < .08), respectively. No misalignment occurred in the stented group, and only one of 19 patients (5%) developed an SMA stenosis that required angioplasty. Overall, patients with unstented SMAs had significantly more adverse events directly attributable to SMA misalignment than the stented group (44% vs 5%, respectively; P < .05).

CONCLUSIONS:

Misalignment of the SMA with the use of unstented unreinforced scallops or fenestrations occurs frequently. Routine stenting of single-wide and large fenestrations, when feasible, may be a safer option for patients undergoing FEVAR.

PMID:
27288103
DOI:
10.1016/j.jvs.2016.02.031
[Indexed for MEDLINE]
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