PURPOSE: To describe a 7-year experience with abdominal aortic aneurysm (AAA) repair using fenestrated Zenith endovascular endografts. METHODS: Six endovascular surgeons from 7 medical centers in Perth, Western Australia, contributed data to this retrospective study of 58 AAA patients (51 men; mean age 75.5+/-8.5 years, range 60-94) treated with fenestrated endografts. Fenestrations were applied to 116 target vessels; more than half of patients had >/=2 target vessels. The results were based on satisfactory deployment of the stent-graft and fenestrations (technical success), technical success and no complications (procedural success), and aneurysm exclusion with no endoleak, rupture, unresolved complications, or dialysis (treatment success). RESULTS: Technical success was 82.8% for patients (90.5% for target vessels), procedural success was 74.1%, and treatment success was 94.8%. There were no cases of conversion or rupture. The 30-day mortality rate was 3.4% (n=2). Over a mean follow-up of 1.4+/-1.2 years, 10 (17.2%) patients experienced loss of a target vessel (9.5% of target vessels). Factors associated with target vessel loss were no stent, >60 degrees neck angulation, multiple renal vessels, and vessel diameter </=4 mm. Four (6.9%) patients developed renal impairment, but none required dialysis. Fourteen (24.1%) patients had a secondary intervention. Unresolved endoleaks persisted in 1 (1.7%) patient. CONCLUSION: Fenestrated endografts extend the treatment options for infrarenal AAAs with necks unsuitable for standard endovascular repair. This early data show a trend toward higher mortality of selected patients with fenestrated endografts than for standard stent-graft repair, but the mortality rate is comparable to open repair. Target vessel occlusion predominantly results from pre-existing disease or the lack of a stent. The lessons learned from this experience contributed toward guidelines for users of fenestrated endografts.
PURPOSE: To describe a 7-year experience with abdominal aortic aneurysm (AAA) repair using fenestrated Zenith endovascular endografts. METHODS: Six endovascular surgeons from 7 medical centers in Perth, Western Australia, contributed data to this retrospective study of 58 AAA patients (51 men; mean age 75.5+/-8.5 years, range 60-94) treated with fenestrated endografts. Fenestrations were applied to 116 target vessels; more than half of patients had >/=2 target vessels. The results were based on satisfactory deployment of the stent-graft and fenestrations (technical success), technical success and no complications (procedural success), and aneurysm exclusion with no endoleak, rupture, unresolved complications, or dialysis (treatment success). RESULTS: Technical success was 82.8% for patients (90.5% for target vessels), procedural success was 74.1%, and treatment success was 94.8%. There were no cases of conversion or rupture. The 30-day mortality rate was 3.4% (n=2). Over a mean follow-up of 1.4+/-1.2 years, 10 (17.2%) patients experienced loss of a target vessel (9.5% of target vessels). Factors associated with target vessel loss were no stent, >60 degrees neck angulation, multiple renal vessels, and vessel diameter </=4 mm. Four (6.9%) patients developed renal impairment, but none required dialysis. Fourteen (24.1%) patients had a secondary intervention. Unresolved endoleaks persisted in 1 (1.7%) patient. CONCLUSION: Fenestrated endografts extend the treatment options for infrarenal AAAs with necks unsuitable for standard endovascular repair. This early data show a trend toward higher mortality of selected patients with fenestrated endografts than for standard stent-graft repair, but the mortality rate is comparable to open repair. Target vessel occlusion predominantly results from pre-existing disease or the lack of a stent. The lessons learned from this experience contributed toward guidelines for users of fenestrated endografts.
Authors: Bjoern D Suckow; Philip P Goodney; Jesse A Columbo; Ravinder Kang; David H Stone; Art Sedrakyan; Jack L Cronenwett; Mark F Fillinger Journal: J Vasc Surg Date: 2017-12-28 Impact factor: 4.268
Authors: Zhonghua Sun; Bibombe P Mwipatayi; Yvonne B Allen; David E Hartley; Michael M Lawrence-Brown Journal: Korean J Radiol Date: 2009-04-22 Impact factor: 3.500
Authors: Frédéric Cochennec; Hicham Kobeiter; Manj S Gohel; Marek Majewski; Jean Marzelle; Pascal Desgranges; Eric Allaire; Jean Pierre Becquemin Journal: J Vasc Surg Date: 2014-04-21 Impact factor: 4.268