Top-fenestrating technique in stentgrafting of aortic diseases with mid-term follow-up.
OBJECTIVE
As a consequence of the rapid growth of thoracic and abdominal endovascular aneurysm repair management of aortic branches has come into focus. The top-fenestrating technique can be used where one or two of the renal arteries, the left carotid artery or the left subclavian artery, have deliberately been covered by a stent-graft and immediately reopened by a preplaced stent. The aim of this study is to evaluate whether this technique is feasible and durable.


METHODS
Registry study on 24 patients endovascular repaired with the top-fenestrating technique between September 2004 and January 2008. Elective operations were performed in 15 patients and acute procedures in nine. The median neck length for the patients having a carotid stent was 0 mm, range -18-15, related to the left subclavian artery and median 11 mm, range 0-31 mm, for those having a renal stent. Altogether 25 stents were used.


RESULTS
There were two postoperative deaths. One patient died from a cardiac infarction and the other, a ruptured thoracic aortic aneurysm, had a major stroke. Median follow-up time was 17 months (range 1-40 months). Two patients died during follow-up from no-aneurysm related reasons. One type I endoleak was solved with a secondary intervention. Two patients had type II endoleak, which was not treated. After 12 months, 71% of the aneurysms had significantly decreased in size. None of the aneurysms had increased. There were no stent-graft migrations in the entire group. None of the stented branches was lost during follow-up.


CONCLUSIONS
The top-fenestrating technique is feasible in short aortic necks and results are durable in a mid-term follow-up perspective.
Larzon
T
T
Department of Surgery, Orebro University Hospital, Orebro, Sweden. thomas.larzon@orebroll.se
Eliasson
K
K
Gruber
G
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001018:Aortic Diseases / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D016893:Carotid Stenosis / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D012042:Registries; D012078:Renal Artery Obstruction / Q000601:surgery; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome