Superior mesenteric artery outcomes after fenestrated endovascular aortic aneurysm repair.
OBJECTIVE
The Zenith (Cook Medical, Bloomington, Ind) fenestrated endovascular graft may be designed with single-wide scallops or large fenestrations to address the superior mesenteric artery (SMA). Misalignment of the SMA with an unstented scallop or a large fenestration is possible. This study assessed SMA outcomes after fenestrated endovascular aortic aneurysm repair (FEVAR).


METHODS
During an 18-month period, 47 FEVARs were performed at a single institution. For analysis, patients were grouped according to unstented (n = 23) vs stented (n = 24) SMA scallops/fenestrations. The Institutional Review Board approved this single-institution observational study. Because this was a retrospective review of the data, patient consent was unnecessary for the study.


RESULTS
Technical success for FEVAR was 100%. The median follow-up period was 7.7 months (range, 1-16 months). Nine of 21 patients (43%) in the unstented group had some degree of misalignment of the SMA (range, 9%-71%). Among these, four patients (44%) developed complications: three SMA stenoses and one occlusion. The mean peak systolic velocity in patients with and without SMA misalignment was 317.8 cm/s vs 188.4 cm/s (P < .08), respectively. No misalignment occurred in the stented group, and only one of 19 patients (5%) developed an SMA stenosis that required angioplasty. Overall, patients with unstented SMAs had significantly more adverse events directly attributable to SMA misalignment than the stented group (44% vs 5%, respectively; P < .05).


CONCLUSIONS
Misalignment of the SMA with the use of unstented unreinforced scallops or fenestrations occurs frequently. Routine stenting of single-wide and large fenestrations, when feasible, may be a safer option for patients undergoing FEVAR.
Division of Vascular Surgery, University of Texas Southwestern Medical Center, Dallas, Tex. Electronic address: salimlala1@gmail.com.
Salim
S
Lala
Division of Vascular Surgery, University of North Carolina, Chapel Hill, NC.
Martyn
M
Knowles
Division of Vascular Surgery, University of Texas Southwestern Medical Center, Dallas, Tex.
David
D
Timaran
Division of Vascular Surgery, Baylor University Medical Center, Dallas, Tex.
Mirza Shadman
MS
Baig
Division of Vascular Surgery, Vanderbilt University, Nashville, Tenn.
James
J
Valentine
Division of Vascular Surgery, University of Texas Southwestern Medical Center, Dallas, Tex.
Carlos
C
Timaran
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D003251:Constriction, Pathologic; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging / Q000601:surgery*; D008641:Mesenteric Vascular Occlusion / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D013781:Texas; D013997:Time Factors; D016896:Treatment Outcome