Outcomes of Fenestrated Endografts in the Treatment of Abdominal Aortic Aneurysm in Western Australia (1997–2004)

Abstract

Fenestrated endografts extend the treatment options for infrarenal AAAs with necks unsuitable for standard endovascular repair. This early data show a trend toward higher mortality of selected patients with fenestrated endografts than for standard stent-graft repair, but the mortality rate is comparable to open repair. Target vessel occlusion predominantly results from pre-existing disease or the lack of a stent. The lessons learned from this experience contributed toward guidelines for users of fenestrated endografts.

Pararenal aortic aneurysm repair using fenestrated endografts

“…Nine studies were included in this analysis. [42][43][44][45][46][47][48][49][50] All studies were observational, two were of prospective and seven of retrospective design. Quality assessment of the studies (Table I) showed a suspected selection bias of patients in most studies.…”

Fenestrated Endovascular Repair for Pararenal Abdominal Aortic Aneurysms: A Systematic Review and Meta-Analysis

“…f-EVAR is a relatively new and challenging technique. High-resolution preoperative imaging is required to analyze the anatomy of the aneurysm 9 NS NS NS NS NS NS Kristmundsson et al 10 5.5 24.0 1.9 NS 5.6 NS Verhoeven et al 11 2.0 NS NS 0 NS NS Greenberg et al 12 10.0 13.3 13.3 0 23.1 0 Troisi et al 13 NS NS NS 1.9 NS 7.5 Halak et al 14 NS NS NS 0 NS NS Semmens et al 15 6.9 NS NS NS NS NS Ziegler et al 16 6. and to undertake accurate procedure planning. It also requires excellent endovascular skills, because even small errors during implantation can result in target vessel loss or endoleaks.…”

“…Among these studies, the most common causes of death were bowel ischemia (n ¼ 3) 10,11,13 and myocardial infarction (n ¼ 3). 9,15 Other causes included acute renal failure (n 10 occlusion of the internal iliac artery (n ¼ 1), 11 pulmonary embolization (n ¼ 1), 15 external iliac artery rupture (n ¼ 1), 18 acute aortic bifurcation occlusion (n ¼ 1), 18 pulmonary edema (n ¼ 1), 18 and lower limb ischemia (n ¼ 1). 19 Technical success rate.…”

Fenestrated stent grafts for the treatment of complex aortic aneurysm disease: A mature treatment paradigm

“…In case of small and calcified external iliac arteries, a retroperitoneal approach and an iliac conduit may be required. The PC is introduced in one side (the delivery sheath of the PC has a diameter of 22-24 Fr and a large (20)(21)(22)(23)(24) sheath is inserted on the contralateral side, each over a stiff wire. The latter is positioned just above the aortic bifurcation and after retrieval of the stiff wire three or four smaller sheaths are introduced through the large sheath valve.…”

“…Some designs are without fenestrations but with branches (pre-attached limbs or cuffs) targeted for the visceral aortic vessels, suitable for the endovascular treatment of thoracoabdominal aortic aneurysms (TAAAs). At least for short-necked and juxtarenal aortic aneurysms (JRAs), fenestrated stent-grafting technology has been shown to be feasible, [12][13][14][15][16][17][18][19][20] with published results of highvolume experienced single centers [21][22][23][24][25][26][27][28][29][30][31] and a few recent multicenter trials 32,33 sharing remarkable short-and midterm results, with the durability of the technique being satisfactory (technical success > 95%, low mortality rates averaging 1-2% and low rates of mid-term branch vessel occlusion averaging 4-9%). [25][26][27][28][29]34 Other imaginative procedures have also been developed or modified to allow for the segmental or complete coverage of the aorta in the region of vital branches, including the 'chimney', 'snorkel', 'periscope' [35][36][37] and combined endovascular exclusion and extra-anatomic mesenteric/renal bypasses (hybrid visceral revascularization).…”