Treatment of Complex Aneurysmal Disease with Fenestrated and Branched Stent Grafts

Objectives: To describe our experience of treating juxtarenal (JRAAA's <4 mm neck) and thoracoabdominal aortic aneurysms (TAAA's) using fenestrated and branched stent graft technology. Design: Prospective single centre experience. Methods: Since 2005, 29 fenestrated/branched procedures have been performed. 15 patients are studied with JRAAAs (n = 7; median neck length 0 mm (IQR 0-3.8)) or TAAAs (type I (n = 2), III (n = 2), IV (n = 4)). ASA grade III in 12/15. Maximum diameter of aneurysm 64 mm (56-74 mm). Aneurysms were excluded using covered stents or branches from the main body to patent visceral vessels (40 target vessels total). Pre-operative and follow-up CT scans (1, 3, and 12 months) were analysed by a single Vascular Interventional Radiologist. Results: Technical success for cannulation and stenting of target vessels was 98%. In-hospital mortality was 0%. One patient underwent conversion to open repair. Five had major complications including one paraplegia (type III TAAA) with subsequent recovery. Median Length of stay was 9 days (IQR 7-18.75). At a median follow-up of 12 months (9-14), CT confirmed 36/37 (97%) target vessels remain patent. Sac size increased >5 mm in one patient only. There were no type I endoleaks, three type II endoleaks (one embolised, two under surveillance) and three type III endoleaks (two successfully treated percutaneously, one aneurysm ruptured 18 months after endografting and died). Conclusion: In selected patients, fenestrated and branched stents appear to be a safe and effective alternative to surgery for juxtarenal and thoracoabdominal aneurysms. The complication and mortality rates are low. The long-term durability of this procedure, however, needs to be proven. Crown Copyright (C) 2008 Published by Elsevier Ltd on behalf of European Society for Vascular Surgery. All rights reserved.