title: Fenestrated and Branched Stent Grafting in Complex Aneurysmatic Aortic Disease: A Single-Center Early Experience.
abstract: BACKGROUND
  The aim of this study is to present our early experience and highlight the technical difficulties associated with the use of fenestrated and branched stent grafts to treat patients with juxtarenal abdominal aortic aneurysm (AAA), pararenal AAA, and thoracoabdominal aortic aneurysms (TAAAs).
  
  
  METHODS
  A prospectively held database maintained at our department was queried for patients who have undergone branched and fenestrated stent grafting for AAA or TAAA treatment. Indication for repair, comorbidity precluding open repair, technical challenges associated with the repair, as well as operative mortality, morbidity, and reintervention rate were evaluated.
  
  
  RESULTS
  A total of 8 patients underwent repair with a fenestrated or branched stent graft. All patients had aneurysmal degeneration of the juxtarenal aorta, pararenal aorta, and thoracoabdominal aorta not suitable to standard endovascular techniques. Two patients had a prior aortic repair, a failed migrated stent graft, and an old surgical tube graft after an open repair. One patient had a type III TAAA and 1 patient had a postdissection TAAA type I. For all patients, target vessel success rate was 96.4% (27/28) and mean hospital stay was 6.0 days (range 3-21). Thirty-day and 1-year mortality were 0%. Mean follow-up was 23 months (range 7-45). Two endoleaks occurred, 1 type III and 1 type II, which were treated endovascularly. No death or major complication occurred during follow-up.
  
  
  CONCLUSIONS
  Fenestrated and branched endovascular stent grafts can be used to repair juxtarenal AAA, pararenal AAA, and TAAA in patients with significant comorbidities. However, several technical challenges have to be overcome due to the unique complex aortic pathology of each patient.
authors.affiliation: Department of Surgery, Division of Vascular Surgery, 401 General Military Hospital of Athens, Athens, Greece.
authors.forename: Georgios D
authors.initials: GD
authors.lastname: Vourliotakis
authors.affiliation: Department of Surgery, Division of Vascular Surgery, 401 General Military Hospital of Athens, Athens, Greece.
authors.forename: Vasileios D
authors.initials: VD
authors.lastname: Tzilalis
authors.affiliation: Department of Surgery, Division of Vascular Surgery, 401 General Military Hospital of Athens, Athens, Greece. Electronic address: pn.theodoridis@gmail.com.
authors.forename: Panagiotis G
authors.initials: PG
authors.lastname: Theodoridis
authors.affiliation: Radiology Department, Division of Digital Subtraction Angiography, 401 General Military Hospital of Athens, Athens, Greece.
authors.forename: Charalampos S
authors.initials: CS
authors.lastname: Stoumpos
authors.affiliation: Radiology Department, Ultrasound Division, 401 General Military Hospital of Athens, Athens, Greece.
authors.forename: Dimitrios G
authors.initials: DG
authors.lastname: Kamvysis
authors.affiliation: Radiology Department, Division of Digital Subtraction Angiography, 401 General Military Hospital of Athens, Athens, Greece.
authors.forename: Ioannis G
authors.initials: IG
authors.lastname: Kantounakis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D015897:Comorbidity; D000072226:Computed Tomography Angiography; D016208:Databases, Factual; D057867:Endoleak / Q000209:etiology; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006115:Greece; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color