Short to midterm outcomes of fenestrated endovascular grafts in the treatment of abdominal aortic aneurysms: a systematic review.
OBJECTIVE
To perform a systematic review of the short to midterm outcomes of fenestrated endovascular grafts in patients with abdominal aortic aneurysms (AAA).


METHODS
A search of PubMed and Medline databases for English-language literature was performed to find studies published between 1999 and 2006. Studies investigating the short to midterm results of fenestrated endovascular grafts for AAA were analyzed for clinical outcomes and postprocedural complications.


RESULTS
Nineteen studies involving fenestrated endovascular grafting were retrieved, and 6 of them met criteria for inclusion in the analysis. The remaining studies were excluded because they dealt with technical or case reports or cumulative addition of previous cases. Pooled estimates (95% confidence interval) of postprocedural complications were 1.1% (0.4%-2.7%) for 30-day mortality; 8.3% (2.9%-13.6%) for late mortality; 97% (92%-100%) and 90% (85%-95%) for perfusion of fenestrated vessels at perioperative and late follow-up, respectively; 13.3% (4.1%-22.5%) for postprocedural renal dysfunction; and 11.2% (3.2%-22.5%) and 9.4% (2.6%-16.3%) for early and late endoleak, respectively. There was correlation between preoperative renal insufficiency and postprocedural renal dysfunction, although this was not a statistically significant difference (p=0.2).


CONCLUSIONS
Our systematic review showed that fenestrated endovascular grafting provides an alternative technique to treat patients with complex aneurysm necks, achieving lower mortality than open repair under comparable conditions. Preoperative renal impairment is a strong indicator of postoperative renal dysfunction. Long-term stability and patency of the fenestrated vessels deserves to be validated.
Sun
Zhonghua
Z
Department of Imaging and Applied Physics, Curtin University of Technology, Bentley, Western Australia.
Mwipatayi
Bibombe P
BP
Semmens
James B
JB
Lawrence-Brown
Michael M D
MM
D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000628:therapy*; D001157:Arterial Occlusive Diseases / Q000209:etiology; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008638:Mesenteric Arteries / Q000601:surgery; D015201:Meta-Analysis as Topic; D018579:Patient Selection; D019106:Postoperative Hemorrhage / Q000209:etiology; D011475:Prosthesis Failure; D012077:Renal Artery / Q000601:surgery; D051437:Renal Insufficiency / Q000209:etiology; D012107:Research Design; D015607:Stents / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency