title: Pararenal aortic aneurysm repair using fenestrated endografts.
abstract: OBJECTIVE
  We performed a systematic review of the current literature to analyze the immediate and follow-up results of fenestrated endovascular aortic aneurysm repair (F-EVAR) in patients with pararenal abdominal aortic aneurysms (AAAs).
  
  
  METHODS
  The Medline, Embase, and Cochrane databases were searched to identify all studies reporting F-EVAR of pararenal AAAs published between January 2000 and May 2011. Two independent observers selected studies for inclusion, assessed the quality of the included studies, and performed the data extraction. Studies were selected based on specific predefined criteria. Outcomes were technical success (successfully completed procedure with endograft patency, preservation of target vessels, and no evidence of type I or III endoleak at postprocedural imaging), 30-day mortality, all-cause mortality, branch vessel patency, renal impairment, and secondary interventions. Between-study heterogeneity was calculated using I(2) statistics. Pooled estimates were calculated using a fixed-effects (I(2) <25%) or a random-effects (I(2) >25% to <50%) model.
  
  
  RESULTS
  Nine studies were included reporting 629 patients who underwent F-EVAR for a pararenal AAA, of which 1622 target vessels were incorporated in an endograft design. Between-study heterogeneity was ≤ 41% for all outcomes. The pooled estimate (95% confidence interval [CI] was 90.4% (87.7%-92.5%) for technical success, 2.1% (1.2%-3.7%) for 30-day mortality, and 16% (12.5%-20.4%) for all-cause mortality. Follow-up was 15 to 25 months. The pooled estimate (95% CI) during follow-up was 93.2% (90.4%-95.3%) for branch vessel patency, 22.2% (16%-30.1%) for renal impairment, and 17.8% (13.5%-22.6%) for secondary interventions.
  
  
  CONCLUSIONS
  Promising immediate and midterm results (up to 2 years) support F-EVAR as a feasible, safe, and effective treatment in a relatively high-risk cohort of patients with pararenal AAAs.
authors.affiliation: Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Matteus A M
authors.initials: MA
authors.lastname: Linsen
authors.forename: Vincent
authors.initials: V
authors.lastname: Jongkind
authors.forename: Denise
authors.initials: D
authors.lastname: Nio
authors.forename: Arjan W J
authors.initials: AW
authors.lastname: Hoksbergen
authors.forename: Willem
authors.initials: W
authors.lastname: Wisselink
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D003952:Diagnostic Imaging; D057510:Endovascular Procedures / Q000379:methods; D006801:Humans; D012077:Renal Artery