title: Fenestrated and Branched Aortic Grafts.
abstract: BACKGROUND
  Abdominal and thoracic aortic aneurysms are diagnosed in 40 and 10 to 15 out of 100 000 persons per year, respectively. Fenestrated (fEVAR) and branched (bEVAR) stent grafts have been developed for abdominal juxtarenal and thoracoabdominal aneurysms. We discuss the patency and complication rates of fEVAR and bEVAR procedures and compare them with the outcome of open surgery.
  
  
  METHODS
  This review is based on pertinent publications from 2011 to 2014 that were retrieved by a selective literature search. The clinical outcomes of case series involving a total of more than 1500 patients are presented. The discussion takes account of recommendations contained in the literature and the authors' own experience.
  
  
  RESULTS
  Open surgery and aortic stent grafting have not been compared in any randomized trial to date. We identified 7 clinical series that included a total of 1270 fEVAR patients and 5 with a total of 408 bEVAR patients. The perioperative mortality after fEVAR procedures was 0-4%. Spinal cord ischemia arose in 1% of cases. The stent patency rate in visceral vessels ranged from 93 to 98%. bEVAR procedures were associated with both higher mortality (4-7%) and more common spinal cord ischemia (4-13%). 5-8% of all patients needed dialysis perioperatively, and the stent patency rate in visceral vessels was 94-97%. Preoperative renal insufficiency was a risk factor for peri-interventional death. Impaired renal function after fEVAR/bEVAR procedures was mainly associated with intermittent lower limb ischemia.
  
  
  CONCLUSIONS
  The results of fEVAR/bEVAR procedures in the last 5 years are similar to those of open surgery. The high postoperative rate of spinal cord ischemia remains a serious problem in the endovascular treatment of thoracoabdominal aortic aneurysms. The decision to implant a stent graft by an endovascular approach or to treat surgically should be made on a case-to-case basis in an interdisciplinary vascular conference.
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center Freiburg, Center for Diagnostic and Therapeutic Radiology, Medical Center-University of Freiburg.
authors.forename: Bartosz
authors.initials: B
authors.lastname: Rylski
authors.forename: Martin
authors.initials: M
authors.lastname: Czerny
authors.forename: Michael
authors.initials: M
authors.lastname: Südkamp
authors.forename: Maximilian
authors.initials: M
authors.lastname: Russe
authors.forename: Matthiase
authors.initials: M
authors.lastname: Siep
authors.forename: Friedhelm
authors.initials: F
authors.lastname: Beyersdorf
mesh_terms: D001014:Aortic Aneurysm / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D001807:Blood Vessel Prosthesis / Q000706:statistics & numerical data*; D006801:Humans; D011183:Postoperative Complications / Q000401:mortality* / Q000517:prevention & control; D015995:Prevalence; D011474:Prosthesis Design; D012307:Risk Factors; D015607:Stents / Q000706:statistics & numerical data; D015996:Survival Rate; D016896:Treatment Outcome