Repair of thoracoabdominal aortic aneurysms with fenestrated and branched endovascular stent grafts.
OBJECTIVE
To report the repair of thoracoabdominal aortic aneurysms (TAAAs) with fenestrated and branched endovascular stent grafts (EVSGs).


METHODS
Four patients with asymptomatic TAAAs were treated with custom-designed Zenith fenestrated and branched EVSGs. Three patients had undergone previous open aortic aneurysm repair. Thirteen visceral vessels in four patients were targeted for incorporation by graft fenestrations and branches.


RESULTS
The fenestration/orifice interface was secured with balloon-expandable Genesis stents or Jostent stent grafts in 9 of 13 target vessels. Completion angiography demonstrated antegrade perfusion in 12 of 13 target vessels. One renal artery occluded because of graft rotation during deployment. There were no endoleaks. Three patients required additional surgical procedures related to access vessels. One patient required reoperation for bleeding from an extra-anatomic bypass graft and subsequently died from multisystem organ failure. Three patients made an uncomplicated recovery. No patient developed spinal cord ischemia. Computed tomography at 12 months in the 3 survivors demonstrated complete aneurysm exclusion with antegrade perfusion in all 10 target vessels.


CONCLUSIONS
TAAA repair with fenestrated and branched EVSGs is feasible and provides an acceptable and promising alternative to conventional surgical repair in selected patients.
Anderson
John L
JL
Ashford Community Hospital, South Australia.
Adam
Donald J
DJ
Berce
Michael
M
Hartley
David E
DE
D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001315:Australia; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome