title: Endovascular treatment options for complex abdominal aortic aneurysms.
abstract: OBJECTIVE
  To report short-term and midterm outcomes of endovascular aneurysm repair (EVAR) of complex aneurysms requiring revascularization of visceral arteries.
  
  
  METHODS
  Prospective data were collected from patients deemed unsuitable for conventional EVAR and conventional surgery who were treated with different endovascular approaches according to the clinical presentation of the aneurysm. Custom-made fenestrated endovascular aneurysm repair (CM f-EVAR) was used in the elective setting, homemade fenestrated endovascular aneurysm repair (HM f-EVAR) or HM f-EVAR combined with chimney endovascular aneurysm repair (ch-EVAR) was used in the emergent setting in patients with hemodynamic stability, and ch-EVAR was used in unstable cases. The study included 34 consecutive patients. Primary outcomes measured were perioperative mortality and morbidity, renal function impairment (RFI), target vessel patency, and survival at mean follow-up.
  
  
  RESULTS
  In the CM f-EVAR group (7 of 34 patients; 20.6%), an intraoperative type III endoleak (1 of 7 patients; 14%) sealed spontaneously. At 8.9 months of follow-up, 1 (1 of 7 patients; 14%) death and 1 (1 of 7 patients; 14%) episode of transient RFI were documented. Visceral vessel patency rate was 95.2%. In the HM f-EVAR group (4 of 34 patients; 11.7%) and the combination of HM f-EVAR and ch-EVAR group (3 of 34 patients; 8.8%), no complications were observed at 17.3 months of follow-up. In the ch-EVAR group (20 of 34 patients; 58.8%), visceral patency was 95% at 30.9 months of follow-up. Two cases of transient RFI and 2 cases of permanent RFI were registered (2 of 20 patients; 10%). One asymptomatic renal artery branch occlusion was observed at 11 months of follow-up. No endoleaks were documented.
  
  
  CONCLUSIONS
  Endovascular aneurysm repair techniques including CM f-EVAR, HM f-EVAR or HM f-EVAR in combination with ch-EVAR, and ch-EVAR are valid tools to maintain blood flow in visceral arteries during treatment of complex aortic aneurysms. The proposed interventional protocol based on clinical presentation was feasible in all cases.
authors.affiliation: Department of Vascular Surgery, San Filippo Neri Hospital, Rome.
authors.forename: Sonia
authors.initials: S
authors.lastname: Ronchey
authors.affiliation: Department of Vascular Surgery, San Filippo Neri Hospital, Rome.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Serrao
authors.affiliation: Department of Vascular Surgery, San Filippo Neri Hospital, Rome.
authors.forename: Holta
authors.initials: H
authors.lastname: Kasemi
authors.affiliation: Vascular Surgery Unit, AOUP "P. Giaccone," University of Palermo, Via Liborio Giuffrè, 5, Palermo 90100, Italy.. Electronic address: felice.pecoraro@unipa.it.
authors.forename: Felice
authors.initials: F
authors.lastname: Pecoraro
authors.affiliation: Department of Vascular Surgery, San Filippo Neri Hospital, Rome.
authors.forename: Stefano
authors.initials: S
authors.lastname: Fazzini
authors.affiliation: Department of Vascular Surgery, San Filippo Neri Hospital, Rome.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Alberti
authors.affiliation: Department of Vascular Surgery, San Filippo Neri Hospital, Rome.
authors.forename: Nicola
authors.initials: N
authors.lastname: Mangialardi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001783:Blood Flow Velocity; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012039:Regional Blood Flow; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency; D014781:Viscera / Q000098:blood supply*