title: Pararenal Aortic Ulcer Repair.
abstract: OBJECTIVE
  In order to investigate techniques and outcomes of pararenal penetrating aortic ulcer (PAU) repair, a retrospective cohort study was performed.
  
  
  METHODS
  Over the 6 year study period, 12 patients treated for a pararenal PAU were included. Outcome measures included technical success, survival, and peri-operative complications, as well as stent patency.
  
  
  RESULTS
  Treatment modalities included hybrid procedures with endovascular aneurysm repair (EVAR) and bypass grafting, chimney EVAR (Ch-EVAR), and fenestrated EVAR (FEVAR). Four of the 12 patients were symptomatic, and eight patients underwent elective surgery. The technical success rate was 100%. Symptom resolution was recorded in all symptomatic patients immediately post-operatively. Complications encountered included one type I endoleak in a patient who underwent Ch-EVAR, and one case of post-operative stroke, paralysis, and death in a patient who underwent FEVAR. No adverse events were recorded in the remaining 10 patients. The PAU protrusion distance was significantly greater in symptomatic patients. Perforation and leakage were more prevalent in patients with pre-operative abdominal or back pain.
  
  
  CONCLUSIONS
  Encouraging results of endovascular treatment of pararenal PAUs were observed. One major and fatal complication was encountered, which underlines the complexity and risks of the techniques. Another patient required re-intervention owing to an endoleak following off label use of covered stents for Ch-EVAR. FEVAR, which generally requires a custom made graft, was increasingly applied over the study period, potentially because of an increased awareness of this distinct pathology allowing for elective procedure planning. Ch-EVAR and hybrid procedures were predominantly used in symptomatic patients, whereas FEVAR was the preferred elective treatment option.
authors.affiliation: Wilhelminenspital Vienna, Department of Vascular and Endovascular Surgery, Montleartstraße 37, 1160 Vienna, Austria. Electronic address: fadi.taher@gmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Taher
authors.affiliation: Wilhelminenspital Vienna, Department of Vascular and Endovascular Surgery, Montleartstraße 37, 1160 Vienna, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Assadian
authors.affiliation: Wilhelminenspital Vienna, Department of Vascular and Endovascular Surgery, Montleartstraße 37, 1160 Vienna, Austria.
authors.forename: J
authors.initials: J
authors.lastname: Strassegger
authors.affiliation: Wilhelminenspital Vienna, Department of Vascular and Endovascular Surgery, Montleartstraße 37, 1160 Vienna, Austria.
authors.forename: N
authors.initials: N
authors.lastname: Duschek
authors.affiliation: Wilhelminenspital Vienna, Department of Vascular and Endovascular Surgery, Montleartstraße 37, 1160 Vienna, Austria.
authors.forename: S
authors.initials: S
authors.lastname: Koulas
authors.affiliation: Wilhelminenspital Vienna, Department of Vascular and Endovascular Surgery, Montleartstraße 37, 1160 Vienna, Austria.
authors.forename: C
authors.initials: C
authors.lastname: Senekowitsch
authors.affiliation: Wilhelminenspital Vienna, Department of Vascular and Endovascular Surgery, Montleartstraße 37, 1160 Vienna, Austria.
authors.forename: J
authors.initials: J
authors.lastname: Falkensammer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001018:Aortic Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D057867:Endoleak / Q000209:etiology; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014456:Ulcer / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D014654:Vascular Patency
keywords: Aortic ulcer; Endovascular aneurysm repair; FEVAR; PAU; Penetrating aortic ulcer