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

Di, Xiao; Ye, Wei; Liu, Changwei; Jiang, Jingmei; Han, Wei; Liu, Bao

doi:10.1016/j.avsg.2013.06.003

Cited by 38 publications

(27 citation statements)

References 29 publications

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“…6,7 However, there is great heterogeneity in reports with regard to patient cohort, indications for repair, techniques, and results. There is poor concurrence in the classification of neck morphology, with various definitions of juxtarenal aneurysm and indications for FEVAR.…”

Section: Discussionmentioning

confidence: 98%

“…However, cannulation of the visceral vessels is technically challenging and is associated with higher morbidity and mortality rates compared with infrarenal EVAR. [5][6][7] A recent systematic review and meta-analysis of 12 studies of FEVAR showed that the pooled 30-day mortality was 2.52%; however, results from individual studies vary widely, ranging from 0% 8 to 7%. 9 One factor that makes comparison between these case series difficult is the lack of consensus as to how to classify the extent of the aneurysm.…”

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confidence: 97%

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Results of complex aortic stent grafting of abdominal aortic aneurysms stratified according to the proximal landing zone using the Society for Vascular Surgery classification

Patel

Constantinou

Simring

et al. 2015

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 98%

mentioning

confidence: 97%

Results of complex aortic stent grafting of abdominal aortic aneurysms stratified according to the proximal landing zone using the Society for Vascular Surgery classification

Patel

Constantinou

Simring

et al. 2015

Journal of Vascular Surgery

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“…2,12,13 As interventionists have become more confident with the use of complex endovascular techniques, increasingly challenging pathologies are now being treated with FEVAR. It is therefore important to stratify results according to aortic anatomy and technical complexities.…”

Section: Discussionmentioning

confidence: 99%

Graft Complexity–Related Outcomes of Fenestrated Endografting for Abdominal Aortic Aneurysms

et al. 2017

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PURPOSE: To report the outcomes of fenestrated endovascular aneurysm repair (FEVAR) and compare early and midterm results in relation to stent-graft complexity. METHODS: Between August 2006 and December 2014, 141 consecutive patients (mean age 72±7.6 years, range 50-89; 120 men) were treated electively with FEVAR for short-neck, juxtarenal, or suprarenal aortic aneurysms. Forty-five patients treated with stent-grafts featuring renal-only fenestrations were assigned to group A, while 96 patients receiving additional fenestrations for the superior mesenteric and/or celiac arteries were assigned to group B. Technical success, operative mortality and morbidity, target vessel patency, endoleak, reintervention, and survival were compared between the groups. Survival, target vessel stent patency, and reintervention during follow-up were estimated by Kaplan-Meier analysis; the estimates are presented with the 95% confidence interval (CI). RESULTS: Technical success was achieved in 135 (95.7%) patients. Overall 30-day operative mortality was 3.5% (5/141). Perioperative complications occurred in 16 (12.1%) patients. Mean follow-up was 33±23 months. Overall estimated survival was 85.1% (95% CI 79.1% to 91.1%) at 1 year and 75.8% (95% CI 68.2% to 83.5%) at 3 years. Freedom from reintervention was 90.6% (95% CI 85.6% to 95.6%) at 1 year and 79.2% (95% CI 71% to 87.5%) at 3 years. There was no statistically significant difference between the groups in terms of perioperative mortality or morbidity, endoleak, survival, target vessel patency, or reintervention. CONCLUSION: The use of FEVAR for juxta-and suprarenal aneurysms is associated with low 30-day mortality/morbidity and high midterm efficacy. So far, perioperative and midterm results are not affected by the use of more complex fenestrated designs.

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“…The technical success, to be able to catheterize target vessels for fenestrations has been almost 100%, but in the follow-up stenosis (6-12%) and occlusion of renal arteries are reported to occur in 2-6% of cases (Di et al 2013). Initially, the drawback with fenestrated SGs was considered to be a high risk of endoleaks type I but this has not been the main complication seen.…”

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confidence: 99%

Impact of Renal Chimney Grafts on Anatomical Suitability for Endovascular Repair in Ruptured Abdominal Aortic Aneurysm

et al. 2015

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Introduction: Open repair of the aorta carries a high risk for morbidity and mortality especially in the elderly population and in patients unfit for major surgery. Endovascular aortic repair is safe, durable and effective when there is adequate proximal and distal sealing zone for the aortic stent graft. Fenestrated and branched stent grafts have made the repair possible for complex but elective cases that do not have an adequate sealing zone. Urgent complex cases and patients with midaortic occlusive diseases do not have any therapeutic alternative if they are not fit for open repair. Chimney graft technique fills this gap and allows the sealing zones for aortic stent graft to be extended as required. The aim of the present thesis is to study the applicability, safety and durability of CG technique in urgent cases with complex lesions in the thoracic and abdominal aorta including the midaortic occlusive diseases. Patients and Methods: All patients who received CG were treated urgently or semi-urgently. The majority of the treated aortic lesions were aneurysms, dissections, pseudoaneurysms, infection, and accidental overstented vital aortic side branches. The median age of all patients was 75 years (IQR, 69-78), of them 32% were female except for the first study where all ten patients were female with midaortic occlusive diseases. The second study evaluated the mid to long-term efficacy and durability of the CG technique in 29 patients with urgent and complex lesions of the thoracic aorta. The third study examined the long-term results of CG in preserving the visceral flow of 51 patients with urgent complex aortic lesions. The fourth study evaluated the CTA images of 206 patients with ruptured abdominal aortic aneurysm. The study measured the applicability of CG in patients for whom standard EVAR was contraindicated because of a short aneurysmal neck. Results:The results showed that CG is applicable and safe for midaortic occlusive diseases with high technical success and patency rate without major adverse effect. The treated patients with thoracic aortic lesions had 14% 30-day mortality, 21% type I endoleak, 7% CG-related mortality, 98% secondary patency and 68% of the aortic lesions shrank significantly. Visceral CG had a 10% 30-day mortality, 6% CG-related mortality, 12% type I endoleak, 93% secondary patency and 63% of the aortic lesions shrank significantly. Twenty-two patients had one renal arteriy sacrificed, 57% of these required permanent renal dialysis. The fourth study proved that CG technique increased the overall suitability for endovascular repair from 34% to 40-46%. Conclusions: Chimney graft seems effective and safe for treating midaortic occlusive diseases in patients unfit for open surgery. The early and mid to long-term results of the CG technique for urgent and complex lesions of the thoracic and abdominal aorta in high-risk patients are promising with a low early mortality, acceptable rate of type I endoleaks and long durability of the CGs, which may justify a broader applicability of this ...

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

Cited by 38 publications

References 29 publications

Results of complex aortic stent grafting of abdominal aortic aneurysms stratified according to the proximal landing zone using the Society for Vascular Surgery classification

Results of complex aortic stent grafting of abdominal aortic aneurysms stratified according to the proximal landing zone using the Society for Vascular Surgery classification

Graft Complexity–Related Outcomes of Fenestrated Endografting for Abdominal Aortic Aneurysms

Impact of Renal Chimney Grafts on Anatomical Suitability for Endovascular Repair in Ruptured Abdominal Aortic Aneurysm

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