Use of Fenestrated Endografts in Treatment of Juxtarenal Aortic Aneurysms with Prior Aortic Repair
Senthil N. Jayarajan, MD, MS, Luis Sanchez, MD, Jeffrey Jim, MD, MPHS.
Washington University in St. Louis School of Medicine, Saint Louis, MO, USA.
OBJECTIVES: Our goal is to evaluate our experience in using FDA-approved custom manufactured fenestrated endografts in patients with juxtarenal abdominal aortic aneurysms and prior aortic repair.
METHODS: A retrospective review of patients treated with fenestrated endovascular aortic aneurysm repair (FEVAR) at two high volume aortic centers over a four year period (2012 to 2015). Demographics, preoperative imaging, surgical technique, branch patency, and patient survival were analyzed.
RESULTS: There were 18 patients (17 males, 94%) with a mean age of 74.5 years (range 55-88) treated with FEVAR for juxtarenal aortic aneurysms with prior aortic repair. There were 11 prior open and 7 endovascular repairs. There was a mean interval of 8.9 years between previous repair and the fenestrated repair. All patients underwent FEVAR with the Cook fenestrated device. The fenestrated endografts were successfully deployed in all cases with planned 45 stents for a total of 50 fenestrations. There were two (11%) 30-day mortalities with one death from multi-system organ failure and another from post-discharge acute myocardial infarction on POD 6. On mean follow-up of 12.0 months, there was one type 3 endoleak that was successfully treated at 8 months. 39/40 (97.5)stents were patent at last followup excluding perioperative mortalities.
CONCLUSIONS: The early results suggest that the use of fenestrated endografts can successfully treat juxtarenal aortic aneurysms in patients with prior open and endovascular aortic repairs. However, longer follow-up is needed to ensure durable success rates in this challenging group of patients.
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