Fenestrated endovascular repair for juxtarenal aortic aneurysm

Abstract

F-EVAR enabled successful treatment of juxtarenal aortic aneurysm with a low complication rate.

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

“…Migration rates between 1% and 7% have been reported, 25,29 or higher in other studies, all requiring re-interventions. 85 Previous evaluation confirmed that insufficient landing zone or imprecise planning of the procedure could explain most of the adverse events, including migrations/ type I endoleak with or without visceral stent fractures.…”

“…85 Series from referral centers have included between 45 and 607 patients, with 117-1907 target vessels. 5,10,29,[32][33][34]39,80,97 Up to July 2012, a total of 2463 target vessels have been accessed through fenestrations and/or scallops, all within the use of the fenestrated Zenith SG. 20 Overall, early target vessel patency rate ranges from 90.5% to 99.7%.…”

“…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).…”

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

“…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.…”

Endovascular Treatment of Thoracoabdominal Aneurysm

“…Modular grafts are extended from an area of normal-caliber aorta in the descending thoracic aorta to a landing zone distally in either the infrarenal aorta or the bilateral iliac arteries. When there is arch involvement, it often [38] 1 1 3 2 7 Button and Jenkins [39] 1 5 0 0 Verhoeven et al [36] 3 0 2 7 [42] 90.7 19 Muhs et al [40] 9 2 4 6 Ziegler et al [43] 92.2 72 Scurr et al [44] 96.6 24 Kristmundsson et al [45] 9 6 2 5 is necessary to first perform open arch replacement using the elephant trunk procedure to provide an area in the proximal descending aorta of suitable caliber to provide a landing zone for the stent graft. Once the graft is deployed, branch vessels are cannulated through it (either through the fenestrations or the branches) and combined with small balloon-expandable covered stents to accommodate visceral arteries.…”