Fenestrated and branched endografts for the treatment of thoracoabdominal aortic aneurysms: a systematic review.
OBJECTIVE
To offer a critical review of the current literature on the use of fenestrated and branched stent-grafts in patients with thoracoabdominal aortic aneurysms (TAAA).


METHODS
A thorough search of the English-language literature published between January 2000 and September 2009 identified reports of endovascular procedures using fenestrated and/or branched endografts as the intended repair strategy in patients with TAAA. Studies were selected based on specific inclusion criteria: (1) >3 high-risk patients with preoperative diagnosis of TAAA, (2) the intended treatment strategy was an endovascular repair using a fenestrated or branched endograft or both, and (3) patient demographics and outcome data (technical success rate, 30-day mortality, and follow-up length) were clearly stated. From 47 articles initially identified, 7 studies were included in the statistical analysis encompassing 155 patients (mean age 74.4 years, range 41-86) with TAAA averaging 69.2 mm in diameter. The mean follow-up was 11.8 months, and the majority of patients had Crawford type IV aneurysms. Outcome measures of eligible studies were tabulated and then analyzed cumulatively.


RESULTS
Technical success was achieved in 94.2% (n = 146) of the 155 patients. Twenty-three (18.4%) primary endoleaks were reported. The 30-day mortality was 7.1% (n = 11), while the 1-year survival rate was 82.6% (n = 128). Three (1.9%) patients developed permanent paraplegia and 2 (1.3%) developed permanent paraparesis; renal failure was reported in 9 (5.8%). Overall follow-up mortality was 16.1% (n = 25).


CONCLUSIONS
Endovascular treatment with fenestrated or/and branched stent-grafts is a new therapeutic option with encouraging results for patients considered unfit for conventional open repair. However, prolonged follow-up studies are needed in order to draw robust conclusions.
Bakoyiannis
Chris N
CN
First Department of Surgery, Vascular Department, University of Athens, "Laiko" General Hospital, Athens, Greece.
Economopoulos
Konstantinos P
KP
Georgopoulos
Sotirios
S
Klonaris
Chris
C
Shialarou
Maria
M
Kafeza
Marina
M
Papalambros
Efstathios
E
D017130:Angioplasty; D017545:Aortic Aneurysm, Thoracic / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D006801:Humans; D018579:Patient Selection; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D015607:Stents; D016896:Treatment Outcome