Fenestrated endovascular aneurysm repair: graft complexity does not predict outcome.
OBJECTIVE
To evaluate the outcomes of endografts designed with renal fenestrations alone vs. more complex designs that accommodate mesenteric arteries in a consecutive series of patients with pararenal aortic aneurysms undergoing endovascular aneurysm repair (EVAR).


METHODS
A retrospective review of data prospectively collected over a 5-year period identified 42 consecutive patients (39 men; mean age 70±7 years) who had undergone fenestrated repair of 3 type IV thoracoabdominal aortic aneurysms (TAAA), 6 suprarenal aneurysms requiring at least 1 renal artery reimplantation, and 33 juxtarenal aneurysms with an infrarenal aortic neck <5 mm long. Operative variables and patient outcomes for complex fenestrated EVAR cases (n = 17) using endografts involving the renal, superior mesenteric, and/or celiac arteries were compared with fenestrated stent-grafts incorporating the renal arteries alone (n = 25). Major morbidity/mortality included death, myocardial infarction (MI), renal failure requiring dialysis, paraplegia, and bowel ischemia.


RESULTS
Of the 95 intended target vessels, 93 (98%) were successfully cannulated and stented (mean 2.2 covered stents per patient). The 30-day mortality was 7% (n = 3), the paraplegia rate was 2% (n = 1), and MI rate was 5% (n = 2). One patient required dialysis for 3 months. Two bridging stent-grafts occluded: one immediately and another at 8 months. Complex fenestrated EVARs were associated with higher risk of major morbidity and mortality (4, 24%) compared to endografts involving the renal arteries alone (2, 8%), but this did not reach statistical significance (p = 0.20). Operation time (mean 205±50 vs. 174±48 minutes, p = 0.07), follow-up duration (mean 8.1±11 vs. 13±17 months, p = 0.29), and reintervention rates (18% vs. 24%, p = 0.72), respectively, were not significantly different between groups.


CONCLUSIONS
In carefully selected patients with pararenal aneurysms, the inclusion of mesenteric arteries in the fenestrated graft design did not influence outcomes compared to fenestrated EVARs involving the renal arteries alone.
St George's Vascular Institute, St George's Healthcare NHS Trust, London, UK. mmetcalfe@doctors.org.uk
Matt J
MJ
Metcalfe
Peter J
PJ
Holt
Robert J
RJ
Hinchliffe
Robert
R
Morgan
Ian M
IM
Loftus
Matt M
MM
Thompson
D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D002445:Celiac Artery / Q000601:surgery; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008131:London; D008297:Male; D008638:Mesenteric Arteries / Q000601:surgery; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000628:therapy; D011474:Prosthesis Design; D012077:Renal Artery / Q000601:surgery; D012086:Reoperation; D012092:Replantation; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome