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Home > Vascular Annual Meeting > kristmundsson_fenestrated_endovascular

Fenestrated Endovascular Repair for Juxtarenal Aortic Pathology

Thorarinn Kristmundsson, Krasnodar Ivancev, Martin Malina, Björn Sonesson, Katarina Björses, Nuno Dias, Timothy Resch.
University Hospital, Malmo, Sweden.

OBJECTIVES: To evaluate the outcomes after fenestrated endovascular aortic repair (fEVAR) in a tertiary European referral center.

METHODS: All patients treated with commercially available custom-made fEVAR between September 2002 and June 2007 were prospectively enrolled in a computerized database including co-morbidities and aneurysm morphology. Patients were retrospectively analyzed. Follow-up consisted of clinical examinations and CT scanning.

RESULTS: 55 patients were included. Mean age was 72 years (range 52-85 years) and 85% were men. Mean preoperative aneurysm diameter was 60 mm (range 44-86 mm). 139 vessels were targeted with scallops (44)/fenestrations (95) and 100 stents/stentgrafts were placed. Target vessel catheterization was achieved in 99% of cases. 3 patients (5.5%) died within 30 days, 2 from trash embolization and multiorgan failure and 1 from retroperitoneal bleeding caused by a renal artery perforation. 3 type 1 endoleaks occurred intraoperatively, 2 sealed pre discharge and 1 was treated with a Palmaz stent on postoperative day 4. 13 patients had type 2 endoleak, 2 required treatment. The median clinical follow-up was 20 months (range 0.5-60 months) with median CT follow-up 13 months (range 0-50 months). Aneurysm diameter decreased by 5 mm or more in 50% of patients at 1 year. 96 percent of target vessels remained patent during the study period. 5 target vessels occluded (2 RA and 3 SMA) without symptoms during follow-up and successful reinterventions were done on 2 stenosed RA. 3 patients suffered creatinine increase but none needed dialysis. 1 late aneurysm related death occurred due to massive bleeding during redo surgery for infection.

CONCLUSIONS: Patients with complex juxtarenal aortic aneurysms carry a higher risk of open surgery compared to standard infrarenal aneurysm repair. In the current series all patients were unfit for open repair. Despite complex anatomy or severe comorbidities in these patients, fenestrated endovascular aortic repair has excellent short- and midterm results and offer a valid treatment alternative to patients unsuitable for standard EVAR or open repair.

AUTHOR DISCLOSURES: T. Kristmundsson, None; K. Ivancev, None; M. Malina, None; B. Sonesson, None; K. Björses, None; N. Dias, None; T. Resch, None.