title: Initial experience of branched endovascular graft for abdominal aortic aneurysm with complex anatomy of proximal neck: planning and technical considerations.
abstract: The purpose of this report was to demonstrate initial Japanese cases of abdominal aortic aneurysm (AAA) with complex anatomy of proximal neck treated using a Zenith fenestrated endograft with branched endovascular technique and to describe the device's design and technical considerations. Planning and sizing of endografts were performed using high-resolution computed tomography on a three-dimensional workstation. Branched endograft technique combined with reinforced fenestrated device and balloon-expandable stent graft was used in two patients because of challenging morphology for the fenestrated device with a bare stent. Successful exclusion of the aneurysm sac was achieved in both patients with antegrade perfusion in incorporated visceral vessels. Endovascular repair using a fenestrated device with graft material incorporating the visceral arteries is feasible. The combination of the reinforced fenestration and the balloon-expandable stent graft can provide an adequate sealing effect for the compromised anatomy. Initial and midterm results are reported with further follow-up and patient accrual.
authors.affiliation: Department of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara, Japan. wataruhigashiura@hotmail.com
authors.forename: Wataru
authors.initials: W
authors.lastname: Higashiura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nagata
authors.forename: Nobuoki
authors.initials: N
authors.lastname: Tabayashi
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Itoh
authors.forename: Shoji
authors.initials: S
authors.lastname: Sakaguchi
authors.forename: Shigeki
authors.initials: S
authors.lastname: Taniguchi
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Kichikawa
authors.forename: Hideo
authors.initials: H
authors.lastname: Uchida
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction / Q000379:methods; D001012:Aorta, Abdominal / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D003287:Contrast Media; D004867:Equipment Design; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D011446:Prospective Studies; D011856:Radiographic Image Enhancement / Q000379:methods; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000601:surgery; D015607:Stents; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D003287:Contrast Media