title: Experience with a novel custom-made fenestrated stent graft in the repair of juxtarenal and type IV thoracoabdominal aneurysms.
abstract: OBJECTIVE
  Fenestrated stent grafting has become increasingly popular as a means to manage complex aortic pathology, including juxta- and pararenal aneurysms. The design of a recently developed custom-made fenestrated stent graft, in theory, confers advantages when managing anatomically challenging aortic morphology. This study evaluated its feasibility in anatomically challenging scenarios.
  
  
  METHODS
  Over a 12-month period, 20 patients received fenestrated stent grafts. Among those, 13 patients with juxtarenal or type IV thoracoabdominal aortic aneurysms underwent endovascular repair with the novel fenestrated stent graft at a single UK institution. Data on aneurysm morphology and immediate and short-term results were collected prospectively.
  
  
  RESULTS
  The mean aneurysmal sac size was 7.3 cm (range, 5.5-10.0 cm). The mean infrarenal neck length was 4.4 mm (range, 0-9 mm), and in three cases was lined by a pre-existing infrarenal stent graft. Nine cases had an infrarenal neck angulation of 60(°) or more in either the anteroposterior or coronal planes. Five cases had ≥50% thrombus at the proximal landing zone. A total of 35 target vessels were cannulated, of which six right renal and four left renal arteries were angulated ≥120(°). Two-thirds of cannulated celiac trunks were angulated ≥120(°), and one cannulated superior mesenteric artery was angulated ≥ 140(°). Seven of the cannulated targets were stenosed more than 60%. One patient had two right renal arteries arising 3 mm from each other. Four right and four left common iliac arteries were angulated ≥90(°) in relation to the infrarenal aorta. Technical success was 100%. Median time from date of procedure to most recent follow-up with computed tomography scanning was 33 weeks. There was no type I or III endoleak. One type II endoleak was observed at the time of most recent computed tomography scanning and treated expectantly. There was a single incident of left renal artery occlusion. One patient required repair of a brachial artery, fasciotomies, and temporary haemofiltration. One patient died from ischemic heart disease 77 weeks after the procedure.
  
  
  CONCLUSIONS
  The use of the novel fenestrated stent graft system in patients with hostile aortic aneurysmal morphology is feasible with acceptable short-term outcomes.
authors.affiliation: Imperial Vascular Unit, Imperial College Healthcare National Health Service Trust, London, United Kingdom. Electronic address: alex.rolls1981@googlemail.com.
authors.forename: Alexander E
authors.initials: AE
authors.lastname: Rolls
authors.affiliation: Imperial Vascular Unit, Imperial College Healthcare National Health Service Trust, London, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Jenkins
authors.affiliation: Imperial Vascular Unit, Imperial College Healthcare National Health Service Trust, London, United Kingdom.
authors.forename: Colin D
authors.initials: CD
authors.lastname: Bicknell
authors.affiliation: Imperial Vascular Unit, Imperial College Healthcare National Health Service Trust, London, United Kingdom.
authors.forename: Celia V
authors.initials: CV
authors.lastname: Riga
authors.affiliation: Imperial Vascular Unit, Imperial College Healthcare National Health Service Trust, London, United Kingdom.
authors.forename: Nick J
authors.initials: NJ
authors.lastname: Cheshire
authors.affiliation: Department of Interventional Radiology, Imperial College Healthcare National Health Service Trust, London, United Kingdom.
authors.forename: Nick
authors.initials: N
authors.lastname: Burfitt
authors.affiliation: Department of Interventional Radiology, Imperial College Healthcare National Health Service Trust, London, United Kingdom.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Hamady
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D057867:Endoleak / Q000209:etiology / Q000628:therapy; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008131:London; D008297:Male; D011446:Prospective Studies; D011474:Prosthesis Design; D012078:Renal Artery Obstruction / Q000209:etiology; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome