Fenestrated endovascular aneurysm repair: Graft complexity does not predict outcome

摘要

Purpose: To evaluate the outcomes of endografts designed with renal fenestrations alone vs. more complex designs that accommodate mesenteric arteries in a consecutive series of patients with pararenal aortic aneurysms undergoing endovascular aneurysm repair (EVAR). Methods: A retrospective review of data prospectively collected over a 5-year period identified 42 consecutive patients (39 men; mean age 70±7 years) who had undergone fenestrated repair of 3 type IV thoracoabdominal aortic aneurysms (TAAA), 6 suprarenal aneurysms requiring at least 1 renal artery reimplantation, and 33 juxtarenal aneurysms with an infrarenal aortic neck <5 mm long. Operative variables and patient outcomes for complex fenestrated EVAR cases (n=17) using endografts involving the renal, superior mesenteric, and/or celiac arteries were compared with fenestrated stent-grafts incorporating the renal arteries alone (n=25). Major morbidity/mortality included death, myocardial infarction (MI), renal failure requiring dialysis, paraplegia, and bowel ischemia. Results: Of the 95 intended target vessels, 93 (98%) were successfully cannulated and stented (mean 2.2 covered stents per patient). The 30-day mortality was 7% (n=3), the paraplegia rate was 2% (n=1), and MI rate was 5% (n=2). One patient required dialysis for 3 months. Two bridging stent-grafts occluded: one immediately and another at 8 months. Complex fenestrated EVARs were associated with higher risk of major morbidity and mortality (4, 24%) compared to endografts involving the renal arteries alone (2, 8%), but this did not reach statistical significance (p=0.20). Operation time (mean 205±50 vs. 174±48 minutes, p=0.07), follow-up duration (mean 8.1±11 vs. 13±17 months, p=0.29), and reintervention rates (18% vs. 24%, p=0.72), respectively, were not significantly different between groups. Conclusion: In carefully selected patients with pararenal aneurysms, the inclusion of mesenteric arteries in the fenestrated graft design did not influence outcomes compared to fenestrated EVARs involving the renal arteries alone.