title: Fenestrated and branched stent-grafting after previous surgery provides a good alternative to open redo surgery.
abstract: OBJECTIVE
  To present our experience using fenestrated and branched endoluminal grafts for Para-anastomotic aneurysms (PAA) following prior open aneurysm surgery, and after previous endovascular aneurysm repair (EVAR) complicated by proximal type I endoleak.
  
  
  METHODS
  Fenestrated and/or branched EVAR was performed on eleven patients. Indications included proximal type I endoleak after EVAR and short infrarenal neck (n=4), suprarenal aneurysm after open AAA (n=4), distal type I endoleak after endovascular TAA (n=1), proximal anastomotic aneurysm after open AAA (n=1), and an aborted open AAA repair due to bleeding around a short infrarenal neck.
  
  
  RESULTS
  The operative target vessel success rate was 100% (28/28) with aneurysm exclusion in all patients. Mean hospital stay was 6.0 days (range 2-12 days, SD 3.5 days). Thirty day mortality was 0%. All cause mortality during 18 months mean follow-up (range 5-44 months, SD 16.7 months) was 18% (2/11) with no deaths from aneurysm rupture. Cumulative visceral branch patency was 96% (27/28) at 42 months. Average renal function remained unchanged during the follow-up period.
  
  
  CONCLUSIONS
  Our report highlights the potential of fenestrated and branched technology to improve re-operative aortic surgical outcomes. The unique difficulties of increased graft on graft friction hindering placement, short working distance, and increased patient co-morbidities should be recognized.
authors.affiliation: Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands. e.l.g.verhoeven@chir.umcg.nl
authors.forename: E L G
authors.initials: EL
authors.lastname: Verhoeven
authors.forename: B E
authors.initials: BE
authors.lastname: Muhs
authors.forename: C J A M
authors.initials: CJ
authors.lastname: Zeebregts
authors.forename: I F J
authors.initials: IF
authors.lastname: Tielliu
authors.forename: T R
authors.initials: TR
authors.lastname: Prins
authors.forename: W T G J
authors.initials: WT
authors.lastname: Bos
authors.forename: B I
authors.initials: BI
authors.lastname: Oranen
authors.forename: F L
authors.initials: FL
authors.lastname: Moll
authors.forename: J J A M
authors.initials: JJ
authors.lastname: van den Dungen
mesh_terms: D017130:Angioplasty / Q000295:instrumentation*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D011474:Prosthesis Design; D012086:Reoperation; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency