Outcomes of fenestrated endografts in the treatment of abdominal aortic aneurysm in Western Australia (1997-2004).
OBJECTIVE
To describe a 7-year experience with abdominal aortic aneurysm (AAA) repair using fenestrated Zenith endovascular endografts.


METHODS
Six endovascular surgeons from 7 medical centers in Perth, Western Australia, contributed data to this retrospective study of 58 AAA patients (51 men; mean age 75.5+/-8.5 years, range 60-94) treated with fenestrated endografts. Fenestrations were applied to 116 target vessels; more than half of patients had >/=2 target vessels. The results were based on satisfactory deployment of the stent-graft and fenestrations (technical success), technical success and no complications (procedural success), and aneurysm exclusion with no endoleak, rupture, unresolved complications, or dialysis (treatment success).


RESULTS
Technical success was 82.8% for patients (90.5% for target vessels), procedural success was 74.1%, and treatment success was 94.8%. There were no cases of conversion or rupture. The 30-day mortality rate was 3.4% (n=2). Over a mean follow-up of 1.4+/-1.2 years, 10 (17.2%) patients experienced loss of a target vessel (9.5% of target vessels). Factors associated with target vessel loss were no stent, >60 degrees neck angulation, multiple renal vessels, and vessel diameter </=4 mm. Four (6.9%) patients developed renal impairment, but none required dialysis. Fourteen (24.1%) patients had a secondary intervention. Unresolved endoleaks persisted in 1 (1.7%) patient.


CONCLUSIONS
Fenestrated endografts extend the treatment options for infrarenal AAAs with necks unsuitable for standard endovascular repair. This early data show a trend toward higher mortality of selected patients with fenestrated endografts than for standard stent-graft repair, but the mortality rate is comparable to open repair. Target vessel occlusion predominantly results from pre-existing disease or the lack of a stent. The lessons learned from this experience contributed toward guidelines for users of fenestrated endografts.
Semmens
James B
JB
Centre for Health Services Research, School of Population Health, The University of Western Australia, Nedlands, WA, Australia. james.semmens@uwa.edu.au
Lawrence-Brown
Michael M D
MM
Hartley
David E
DE
Allen
Yvonne B
YB
Green
Roslyn
R
Nadkarni
Sanjay
S
D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012077:Renal Artery / Q000293:injuries / Q000473:pathology; D051437:Renal Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome; D014904:Western Australia