Single Centre Experience with Anaconda Custom-made Fenestrated Stent Graft in the Endovascular Repair of the Juxtarenal Aneurysms

Abstract

Aim: The fenestrated Anaconda custom-made stent graft is one of the recently widely accepted fenestrated devices for managing complex juxta- and pararenal aortic pathology. This study showed its feasibility for treatment of challenging juxtarenal anatomy of the abdominal aorta. Methods: Over the period of 12 months, 9 patients with juxtarenal aortic aneurysm underwent fenestrated stent graft implantation in our institution. The graft fenestrations were customized on the basis of computerized tomography (CT-Angiography; CTA). Selected visceral ostia were protected with covered balloon-expandable stents after partial stent graft deployment. The perioperative and short term data were collected prospectively. Results: The mean aneurysm diameter was 58.4 mm (range 46-73 mm). The mean infrarenal neck length was 3.5 mm (range 0-7 mm), no patient had a severe (>60°) angulation of proximal neck. 18 fenestration for renal arteries, 1 for SMA and 3 for coeliac´s were treated with Advanta V12 covered stent. All the target vessels were cannulated successfully through fenestrations and all the stent grafts were successfully deployed in patients with no technical issue in the release mechanism. All the patients have undergone 6 month follow-up, no aneurysm related or aneurysm-unrelated deaths were reported. On the CTA scan, 3 of the patients had a weak type IIb endoleak; no type I or Type III endoleak was demonstrated. All target vessels were open without an instance of branch-stent stenosis/occlusion. No reintervention was needed. Conclusion: The usage of custom-made Anaconda fenestrated stent graft for endovascular treatment of juxtarenal aortic aneurysms is feasible with acceptable intermediate-term results.

Systematic review of the results of fenestrated endovascular aortic repair in octogenarians

“…Technical success rate was reported in nine studies and ranged from 78% to 100%. 1 , 2 , 13 , 14 , 16 – 19 There was no significant difference between technical success in octogenarians and non-octogenarians in any of the studies.…”

“…Table 6 shows the baseline characteristics of the patients in the included studies. A significantly lower baseline estimated glomerular filtration rate in octogenarians than in non-octogenarians was observed in four studies 1 , 14 – 16 and a significantly higher incidence of hypercholesterolaemia was noted by Henstra et al . 1 A significantly higher incidence of cancer as well as significantly lower incidences of chronic obstructive pulmonary disease and hypercholesterolaemia in octogenarians were reported by Motta et al .…”

“…The characteristics of the 11 included studies are summarised in Table 2 . Six papers described single centre cohorts, 14 , 16 – 20 two studies included data from two centres 1 , 13 and three studies involved national level cohorts. 2 , 15 , 21 Data in most of the studies were collected prospectively in databases for complex AAA repairs and were studied retrospectively.…”

“…Ten studies included patients with juxtarenal/pararenal AAA, 1 , 2 , 13 , 14 , 16 – 21 with four studies including patients with type Ia endoleaks 1 , 14 , 16 , 19 and six studies including patients with TAAA. 2 , 16 – 20 One study did not specify the anatomical extent of the treated aneurysms.…”

“… 15 , 16 , 21 Six studies included devices from Cook Medical (Bloomington, IN, US) 1 , 2 , 13 , 17 , 19 , 20 and three studies included devices from Terumo Aortic (Inchinnan, UK). 1 , 14 , 18 …”