title: Treatment of complex aneurysmal disease with fenestrated and branched stent grafts.
abstract: OBJECTIVE
  To describe our experience of treating juxtarenal (JRAAA's <4mm neck) and thoracoabdominal aortic aneurysms (TAAA's) using fenestrated and branched stent graft technology.
  
  
  METHODS
  Prospective single centre experience.
  
  
  METHODS
  Since 2005, 29 fenestrated/branched procedures have been performed. 15 patients are studied with JRAAAs (n=7; median neck length 0mm (IQR 0-3.8)) or TAAAs (type I (n=2), III (n=2), IV (n=4)). ASA grade III in 12/15. Maximum diameter of aneurysm 64 mm (56-74 mm). Aneurysms were excluded using covered stents or branches from the main body to patent visceral vessels (40 target vessels total). Pre-operative and follow-up CT scans (1, 3, and 12 months) were analysed by a single Vascular Interventional Radiologist.
  
  
  RESULTS
  Technical success for cannulation and stenting of target vessels was 98%. In-hospital mortality was 0%. One patient underwent conversion to open repair. Five had major complications including one paraplegia (type III TAAA) with subsequent recovery. Median length of stay was 9 days (IQR 7-18.75). At a median follow-up of 12 months (9-14), CT confirmed 36/37 (97%) target vessels remain patent. Sac size increased >5 mm in one patient only. There were no type I endoleaks, three type II endoleaks (one embolised, two under surveillance) and three type III endoleaks (two successfully treated percutaneously, one aneurysm ruptured 18 months after endografting and died).
  
  
  CONCLUSIONS
  In selected patients, fenestrated and branched stents appear to be a safe and effective alternative to surgery for juxtarenal and thoracoabdominal aneurysms. The complication and mortality rates are low. The long-term durability of this procedure, however, needs to be proven.
authors.affiliation: St Mary's Regional Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom. colin.bicknell@imperial.ac.uk
authors.forename: C D
authors.initials: CD
authors.lastname: Bicknell
authors.forename: N J W
authors.initials: NJ
authors.lastname: Cheshire
authors.forename: C V
authors.initials: CV
authors.lastname: Riga
authors.forename: P
authors.initials: P
authors.lastname: Bourke
authors.forename: J H N
authors.initials: JH
authors.lastname: Wolfe
authors.forename: R G J
authors.initials: RG
authors.lastname: Gibbs
authors.forename: M P
authors.initials: MP
authors.lastname: Jenkins
authors.forename: M
authors.initials: M
authors.lastname: Hamady
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000209:etiology / Q000601:surgery; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D019992:Databases as Topic; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D010264:Paraplegia / Q000209:etiology; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome