Fenestrated aortic endografts for juxtarenal aortic aneurysm: medium term outcomes

Abstract

Aims: The utility of fenestrated-endovascular aneurysm repair (FEVAR) remains uncertain. This study examines the medium term outcomes of patients undergoing FEVAR for asymptomatic juxtarenal abdominal aortic aneurysm (AAA).

Methods: Consecutive patients undergoing elective FEVAR for juxtarenal AAA at a single tertiary centre were studied between October 2005 and March 2010. Patients were followed up for at least six-months within a protocol including clinical examination, laboratory studies, CT and duplex imaging, and abdominal radiographs. Outcomes were assessed in terms of survival, target vessel patency and graft related complications.

Results: Twenty-nine patients were analysed on an intention to treat basis. There were 27 men and two women of median (range) age 74 (54-86) years. Mean (SD) aneurysm diameter was 68 (7) mm. Median (range) ASA score was 3 (2-4). No procedures required conversion to an open procedure, but one procedure was abandoned. Seventy-nine visceral vessels were perfused through a fabric fenestration or scallop. All vessels remained patent at completion angiography. No patients died within 30-days of surgery. During follow up there were four (14%) deaths at a median (range) of 17 (8-21) months after aneurysm repair. None of these deaths were aneurysm related. Eighteen (62%) patients suffered one or more graft related complications, of whom 11 (38%) required one or more early or late reintervention.

Conclusions: Fenestrated aortic endografts can be utilized safely in the management of juxtarenal AAA in patients at high-risk for open surgery. However, the rate of graft related complication and reintervention is high at medium term follow up.