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. 2007 Jun;24(2):211-20.
doi: 10.1055/s-2007-980049.

Fenestrated aortic stent grafts

James R H Scurr  1 , Richard G McWilliams
Affiliations

Fenestrated aortic stent grafts

James R H Scurr et al. Semin Intervent Radiol. 2007 Jun.

Abstract

Fenestrated stent grafts have been developed to offer an endovascular treatment option to those patients with abdominal aortic aneurysms whose infrarenal necks are anatomically unsuitable for endovascular repair with standard infrarenal devices. The ability to have customized fenestrations that will preserve flow to essential visceral arteries allows proximal seal and fixation to be achieved at and above the renal level. This article discusses patient selection, stent-graft design, and the importance of accurate planning. Deployment techniques along with complications and their avoidance are considered. The published midterm results are reviewed and appear to justify the continued use and evaluation of this technique as an alternative to open surgical repair in high-risk patients with infrarenal necks unsuitable for standard endovascular repair.

Keywords: Fenestrated endovascular aneurysm repair.

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Figures

Figure 1
Figure 1
Intraprocedural image with partial deployment of the proximal component of a fenestrated graft. Sheaths and stents are positioned in both renal arteries and the superior mesenteric artery. The anterior check mark, overlapping vertical anterior and horizontal posterior markers, and the marginal fenestration markers are shown.
Figure 2
Figure 2
(A,B) Multiplanar reformatted computed tomography images showing the interrenal separation. The axial distance between the renal arteries is 4.5 mm. The true distance is 8 mm correcting for lateral angulation and anticipating the lie of the stent graft after deployment.
Figure 3
Figure 3
(A) Intraoperative angiogram during fenestrated endovascular aneurysm repair of a juxtarenal aneurysm. (B) Angiography is performed after releasing the first two stents. Manipulation at this stage is usually easy because of the partial deployment and diameter-reducing ties. (C) Completion angiogram shows patent renal arteries and no endoleak.
Figure 4
Figure 4
The anchor stent has been released and the proximal component is now fully deployed. The renal stents will be deployed next.
Figure 5
Figure 5
Postoperative axial computed tomography image. The arrows point to the marginal markers of a scallop for the superior mesenteric artery (SMA). The scallop is not aligned with the SMA ostium, resulting in severe shuttering.
Figure 6
Figure 6
Postoperative surveillance abdominal radiograph shows crushing of the proximal right renal stent.
Figure 7
Figure 7
Computed tomography reconstruction following complex fenestrated endovascular aneurysm repair showing stents in the renal arteries and superior mesenteric artery. The celiac axis remains patent through a scallop in the upper graft. (Image courtesy of Rao Vallabhaneni and generated using the Aquarius Workstation [TeraRecon, San Mateo, CA]).
None
See this image and copyright information in PMC

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