The fate of target visceral vessels after fenestrated endovascular aortic repair--general considerations and mid-term results

Abstract

Objective: To carry out a retrospective analysis of the short and mid-term target vessels (TV) patency following fenestrated endovascular aortic repair (f-EVAR) of abdominal aneurysm (AAA).

Patients and methods: Seventeen f-EVAR patients were analysed. The Zenith (Cook) fenestrated graft was used in all cases. Bare renal stents were used where good apposition existed between the stent graft and the aortic wall, and covered stents were chosen when this apposition appeared deficient.

Results: A total of 35 TV were treated: twenty with small fenestration and 15 with a scallop. Procedural technical success was achieved in 16 out of 17 patients. All TV were perfused at the completion angiography. Access to TV through small fenestrations was achieved in 18 out of 20 vessels. After a mean follow-up of 20.5 months no type I endoleaks were detected. No late complications were observed in any of the stented TV. One patient with perioperative bilateral renal artery occlusion remains on haemodialysis. One non-target renal artery, opposite a scallop was unintentionally covered. One kidney, initially perfused via a un-stented scallop fenestration, was atrophied 14 months post surgery. One patient died from heart failure.

Conclusions: f-EVAR is a valid and safe treatment option. Our series and the world literature demonstrates a >90% TV preservation rate. Long-term intensive surveillance is required.