title: The endovascular treatment of juxta-renal abdominal aortic aneurysm using fenestrated endograft: early and mid-term results.
abstract: BACKGROUND
  The aim of the present study was to evaluate the early and mid-term results of the endovascular treatment of juxta-renal abdominal aortic aneurysms (j-AAA) using fenestrated endograft (FEVAR).
  
  
  METHODS
  Between 2008 to 2013 all consecutive patients underwent FEVAR using Cook-Zenith fenestrated endograft for treating j-AAA (proximal neck length <5 mm) with renal aortic α/β angle <60°, were prospectively collected in a database. Cardiovascular risk factors, comorbidities, aortic-iliac morphological features, intra and post-procedural data were analyzed. Preoperative FEVAR planning was performed by a thoraco-abdominal computer tomography angiography (CTA) and the 3D/Center Lumen Line reconstructions (3mensio Medical Imaging, Bilthoven, The Netherlands). Follow-up was conducted by duplex ultrasound (DUS)/ contrast enhancement DUS (CEUS) and/or CTA at 1, 6, and 12 months, and yearly thereafter. Early endpoints were technical (TS) and clinical success (CS), renal function worsening (≥30% of preoperative creatinine value) and type I/III endoleak. Mid-term endpoints were: type I/III endoleak, target visceral vessels patency, j-AAA shrinkage, freedom from reintervention and survival.
  
  
  RESULTS
  Twenty patients (94.7% of whom male; mean age: 73.4±5.9 years; ASA≥3: 100%) were enrolled. The mean neck length and j-AAA diameter were 2±1.4 mm (range: 0-4 mm) and 54.9±5 mm, respectively. Eleven (55%) endograft with two fenestrations and a scallop, 8 (45%) with three fenestrations and a scallop, and one (5%) with one fenestration and a scallop were implanted. Sixty-seven visceral vessels were re-vascularized. TS and CS were 100% and 95%, respectively (1/20 30-day mortality). Perioperative renal function worsening was observed in 15% of cases. The mean follow-up was 25±20 months (range: 2-72 months). No type I/III endoleak or occlusion of target visceral vessels occurred. There was j-AAA shrinkage in 65% of patients and no cases of j-AAA enlargement were observed. There were no FEVAR-related reinterventions. Survival at 12, 24, and 36 months were 89.4%, 80.5%, and 80.5%, respectively.
  
  
  CONCLUSIONS
  According to our results, the endovascular treatment for j-AAA, with α/β angle <60°, is safe and effective.
authors.affiliation: Division of Vascular Surgery, University of Bologna, S. Orsola-Malpighi Polyclinic Hospital, Bologna, Italy - enrico.gallitto@gmail.com.
authors.forename: Enrico
authors.initials: E
authors.lastname: Gallitto
authors.affiliation: Division of Vascular Surgery, University of Bologna, S. Orsola-Malpighi Polyclinic Hospital, Bologna, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Gargiulo
authors.affiliation: Division of Vascular Surgery, University of Bologna, S. Orsola-Malpighi Polyclinic Hospital, Bologna, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Freyrie
authors.affiliation: Division of Vascular Surgery, University of Bologna, S. Orsola-Malpighi Polyclinic Hospital, Bologna, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Mascoli
authors.affiliation: Division of Vascular Surgery, University of Bologna, S. Orsola-Malpighi Polyclinic Hospital, Bologna, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Massoni Bianchini
authors.affiliation: Division of Vascular Surgery, University of Bologna, S. Orsola-Malpighi Polyclinic Hospital, Bologna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ancetti
authors.affiliation: Division of Vascular Surgery, University of Bologna, S. Orsola-Malpighi Polyclinic Hospital, Bologna, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Faggioli
authors.affiliation: Division of Vascular Surgery, University of Bologna, S. Orsola-Malpighi Polyclinic Hospital, Bologna, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Stella
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D000072226:Computed Tomography Angiography; D016208:Databases, Factual; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency