Experience With Fenestrated Endovascular Repair of Juxtarenal Abdominal Aortic Aneurysms at a Single Center

Abstract

To present the early and mid-term results of fenestrated endovascular aneurysm repair (FEVAR) using the Zenith fenestrated device for juxtarenal abdominal aortic aneurysms (JAAAs) at our center in China.Design: Retrospective study.The study included 15 male patients with JAAAs, who underwent FEVAR using the Zenith fenestrated device at our center between February 2011 and June 2015.All custom-made Zenith fenestrated devices were designed according to computed tomography angiography (CTA) images obtained preoperatively. The patients with renal insufficiency underwent duplex ultrasonography, while the patients with normal renal function underwent 3 CT data acquisitions including nonenhanced CT, arterial phase, and venous phase. These examinations and blood examinations were completed at 3, 6, and 12 months after discharge, and annually thereafter.The mean age of the patients was 73.13 ± 9.06 years (range, 57–86 years), and the median follow-up period was 30 months (8–52 months). Small fenestrations were used in 27 renal arteries, scallops were used in 7 superior mesenteric arteries (SMAs) and 2 renal arteries, and large fenestrations were used in 2 SMAs. Conversion to an open procedure was not required in any of the patients, and the technical success rate was 100%. The mean length of hospital stay was 11.33 ± 2.02 days (7–15 days). No patient died within the 1st 30 days after the operation. One patient had a type Ia endoleak, which disappeared at 6 months after the operation, 1 patient had a type Ib endoleak, which was detected at 17 months after the operation, and 2 patients had type II endoleaks. One patient died at 17 months and another patient died at 30 months after the operation. Therefore, the all-cause mortality rate was 13.33% (2/15). The target vessel patency rate was 100% without occlusion.The early and mid-term results of FEVAR using the Zenith fenestrated device were good, demonstrating that this procedure is effective for the treatment of JAAAs.

Institutional experience with the Zenith Fenestrated aortic stent graft

“…Thus far, there have been limited outcomes reports outside of the clinical trial setting regarding the results of ZFEN for short-necked infrarenal and juxtarenal aneurysms. [8][9][10][11] Traditionally, short-necked infrarenal and juxtarenal aneurysms required an open operation and suprarenal cross-clamping. This exposed the patient to a significant physiologic stress and renal insult.…”

Numerical simulation of fenestrated graft deployment: Anticipation of stent graft and vascular structure adequacy

“…As the 0.02 mm graft thickness is lower than the other graft dimensions, it is modelled using triangular shell elements. The node coordinates of the ends of the beam elements used to model the stents can be derived from Equations (1) and (2). In this manner, a few nodes of the graft coincide with those of the stents.…”

“…However, nearly 15% of patients have short necks, that is, the length of the healthy aorta between the renal arteries and beginning of the aneurism sac is less than 10 mm. 2 This vascular segment (corresponding to the SG sealing area in conventional EVAR procedures) is extremely short, making it difficult to ensure sufficient sealing and avoid endoleaks. In such cases, a fenestrated SG with lateral fenestrations can be deployed above the visceral arteries (renal arteries, superior mesenteric artery, and celiac trunk).…”

3D printed abdominal aortic aneurysm phantom for image guided surgical planning with a patient specific fenestrated endovascular graft system

“…Therefore, the treatment strategy for patients diagnosed with AAAs is an elective aortic repair procedure with the goal of preventing rupture [5] . The current minimally invasive procedure is referred to as EndoVascular Aortic Repair stent grafting (EVAR), first documented in 1991 [6] .…”

“…Though effective, a substantial patient population is not eligible for EVAR due to the presence of an anatomical complexity characterized by a short proximal neck - less than 10 mm of normal aorta between the renal artery takeoff and aneurysm sac. This anatomical characteristic is inherent to a Juxtarenal Abdominal Aortic Aneurysm (JAAA), found in approximately 15% of AAA cases [5] .…”