Pararenal aortic aneurysm repair using fenestrated endografts

Linsen, Matteus A. M.; Jongkind, Vincent; Nio, D.; Hoksbergen, Arjan W.J.; Wisselink, Willem

doi:10.1016/j.jvs.2011.10.092

Cited by 75 publications

(60 citation statements)

References 56 publications

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“…20 Previous systematic reviews used to report favorable perioperative outcomes. 2,4,21 However, there is only limited evidence considering mid-and long-term outcomes of f-EVAR. Assessment of target vessel patency and postoperative renal function have been scarce and confined only to some large centers.…”

Section: Discussionmentioning

confidence: 99%

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

Liu

et al. 2013

Annals of Vascular Surgery

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Section: Discussionmentioning

confidence: 99%

“…These results confirmed the results of previously published studies. 2e4, 21 In addition, f-EVAR can be performed with acceptable 12-month target vessel patency, reintervention, target renal artery occlusion, and postoperative permanent dialysis rates.…”

Section: Discussionmentioning

confidence: 99%

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

Liu

et al. 2013

Annals of Vascular Surgery

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“…Within this subgroup, 50–60% of cases are ineligible for EVAR due to proximal aortic neck anatomy limitations 2, 3 . To overcome these challenges, a variety of endovascular procedures have emerged to extend proximal landing zones including custom fenestrated/branched grafts, surgeon-modified devices, as well as “chimney”, “periscope” and “sandwich” EVAR techniques.…”

Section: Introductionmentioning

confidence: 99%

Critical analysis of results after chimney endovascular aortic aneurysm repair raises cause for concern

Scali

Feezor

Chang

et al. 2014

Journal of Vascular Surgery

103

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Objective Chimney” techniques used to extend landing zones for endovascular aortic repair(chEVAR) have been increasingly reported; however, concerns about durability and patency remain. The purpose of this analysis was to examine mid-term outcomes of chEVAR. Methods All patients at the University of Florida treated with chEVAR were reviewed. Major adverse events(MAEs) were recorded and defined as any chimney stent thrombosis, type 1a endoleak in follow-up, reintervention, 30-day/in-hospital death and/or ≥ 25% decrease in estimated glomerular filtration rate after discharge. Primary end-points included chimney stent patency and freedom from MAE. Secondary end-points included complications and long-term survival. Results From 2008–2012, 41 patients[age ± standard deviation(SD); 73±8; male 66%(N=27)] were treated with a total of 76 chimney stents(renal, N=51; superior mesenteric artery, N=16 celiac artery, N=9) for a variety of indications: juxtarenal, 42%(N=17, 1 rupture); suprarenal, 17%(N=7), and thoracoabdominal aneurysm, 17%(N=7); aortic anastomotic pseudoaneurysm, 15%(N=6; 3 ruptures), type 1a endoleak after EVAR, 7%(N=3), and atheromatous disease, 2%(N=1). Two patients had a single target vessel abandoned due to cannulation failure and one had a type 1a endoleak at case completion(technical success = 93%). Intraoperative complications occurred in 7 patients(17%), including graft maldeployment with unplanned mesenteric chimney(N=2) and access vessel injury requiring repair(N=5). Major postoperative complications developed in 20%(N=8). 30-day and in-hospital mortality were 5%(N=2) and 7%(N=3), respectively. At median follow-up of 18.2(range 1.4–41.5) months, 28 of 33(85%) patients with available postoperative imaging experienced stabilization or reduction of AAA sac diameters. Nine(32%) patients developed endoleak at some point during follow-up [type 1a, 7%(N=3); type 2, 10%(N=4); indeterminate, 7%(N=3)], and one patient underwent open, surgical conversion. The estimated probability of freedom from reintervention(±standard error mean) was 96±4% at both 1 and 3 years. Primary patency of all chimney stents was 88±5% and 85±5% at 1 and 3 years, respectively. Corresponding freedom from MAEs was 83±7% and 57±10% at 1 and 3 years. The 1 and 5-year actuarial estimated survival for all patients was 85±6% and 65±8%, respectively. Conclusions These results demonstrate that chEVAR can be completed with a high degree of success; however perioperative complications and MAEs during follow-up, including loss of chimney patency and endoleak may occur at a higher rate than previously reported. Elective use of chEVAR should be performed with caution and comparison to open and/or fenestrated EVAR is needed to determine long-term efficacy of this technique.

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“…We observed a single case of acute RFI managed conservatively without dialysis. A longer overlapping zone between the components can reduce the risk of type III endoleak (12,14); the single (14%) case we observed sealed spontaneously early on. The major concern of CM f-EVAR is the manufacturing time that limits its applicability in the emergent setting.…”

Section: Discussionmentioning

confidence: 64%

“…The single SMA occlusion we observed was responsible for the single death during follow-up. RFI after CM f-EVAR was reported in 22.2% of patients, and 2.1% required permanent dialysis (12). Loss of branch patency, prolonged catheter manipulation, and high volume of contrast medium administration are associated with an increased risk of RFI (13).…”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment Options for Complex Abdominal Aortic Aneurysms

Ronchey¹,

Serrao²,

Kasemi³

et al. 2015

Journal of Vascular and Interventional Radiology

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Pararenal aortic aneurysm repair using fenestrated endografts

Abstract: Promising immediate and midterm results (up to 2 years) support F-EVAR as a feasible, safe, and effective treatment in a relatively high-risk cohort of patients with pararenal AAAs.

Cited by 75 publications

References 56 publications

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

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

Critical analysis of results after chimney endovascular aortic aneurysm repair raises cause for concern

Endovascular Treatment Options for Complex Abdominal Aortic Aneurysms

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