title: Anatomic feasibility of off-the-shelf fenestrated stent grafts to treat juxtarenal and pararenal abdominal aortic aneurysms.
abstract: OBJECTIVE
  The objective of this study was to evaluate the anatomic feasibility of two off-the-shelf fenestrated stent graft designs to treat juxtarenal and pararenal abdominal aortic aneurysms (AAAs).
  
  
  METHODS
  Digital computed tomography angiograms were analyzed in 520 consecutive patients treated by open or fenestrated endovascular repair for complex AAAs (2000-2012). The anatomic feasibility of two off-the-shelf fenestrated designs, Endologix Ventana (Endologix Inc, Irvine, Calif) and Cook p-Branch (Cook Medical, Brisbane, Australia), was analyzed with the instructions for use (IFU) proposed by investigational protocols.
  
  
  RESULTS
  There were 390 patients (75%) with juxtarenal and pararenal AAAs considered potential candidates for one of the two devices. Proximal seal (>15 mm) was achieved in all patients with the p-Branch and in 61% of the patients with the Ventana stent graft (P < .0001). The ability to incorporate visceral arteries was greater with the Ventana (90% vs 61%) compared with the p-Branch design (P < .0001). Less than a third of patients met strict IFU criteria with Ventana (27%) or p-Branch (33%; P < .05). By liberal IFU criteria, 42% of patients were candidates for Ventana and 49% for p-Branch (P < .03). Overall, 63% of the patients with juxtarenal and pararenal AAAs were candidates for endovascular repair with one of the two devices.
  
  
  CONCLUSIONS
  The p-Branch design has greater anatomic feasibility and achieves proximal seal in all patients with juxtarenal and pararenal AAAs but is not able to incorporate visceral arteries in 40% of patients. The Ventana design allows incorporation of the visceral arteries in 90% of patients but fails to provide sufficient seal in 40%. Nearly 40% of juxtarenal and pararenal AAAs do not meet anatomic criteria for endovascular repair with one of the two devices, justifying the need for additional designs.
authors.affiliation: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
authors.forename: Bernardo C
authors.initials: BC
authors.lastname: Mendes
authors.affiliation: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn. Electronic address: oderich.gustavo@mayo.edu.
authors.forename: Gustavo S
authors.initials: GS
authors.lastname: Oderich
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minn.
authors.forename: Thanila A
authors.initials: TA
authors.lastname: Macedo
authors.affiliation: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
authors.forename: Alexandre A
authors.initials: AA
authors.lastname: Pereira
authors.affiliation: Department of Epidemiology and Biostatistics, Mayo Clinic, Rochester, Minn.
authors.forename: Stephen
authors.initials: S
authors.lastname: Cha
authors.affiliation: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
authors.forename: Audra A
authors.initials: AA
authors.lastname: Duncan
authors.affiliation: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
authors.forename: Peter
authors.initials: P
authors.lastname: Gloviczki
authors.affiliation: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Bower
mesh_terms: D001012:Aorta, Abdominal / Q000000981:diagnostic imaging*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography; D001807:Blood Vessel Prosthesis; D057510:Endovascular Procedures / Q000379:methods*; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D011474:Prosthesis Design; D015203:Reproducibility of Results; D012189:Retrospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome