Fenestrated Endovascular Aortic Aneurysm Repair (FEVAR) for Complex Thoracoabdominal and Abdominal Aortic Aneurysms: First Iranian FEVAR Series Report with Mid-Term Follow-Up

Abstract

Endovascular treatment of aortic diseases has improved in recent years. More complex thoracoabdominal and juxtarenal abdominal aortic aneurysms can now be treated with new stent grafts and techniques. Fenestrated endovascular aortic aneurysm repair (FEVAR) with fenestrated stent grafts was commenced in our center after hundred cases of endovascular aortic repair, and so far 4 serial complex cases deemed inoperable (2 juxtarenal abdominal aortic aneurysms, 1 thoracoabdominal aneurysm, and 1 thoracoabdominal pseudoaneurysm) have been treated with FEVAR. All these patients needed custom-made stent grafts, which were designed and implanted successfully under general anesthesia in the catheterization laboratory. They were followed up for more than 1 year, with a median follow-up period of 23.0 months. There were no major in-hospital or short-term complications. Only 1 patient had midterm unilateral iliac artery thrombosis, which was successfully managed interventionally. Computed tomography angiography at 1 year's follow-up showed that the stent grafts were patent and their visceral branch cover stents had no endoleak.

Keywords: Aorta; Aortic aneurysm; Iran; Stents.

Figure 1

A1 & A2: Computed tomography angiography of the thoracoabdominal aorta, showing a pseudoaneurysm (arrows); B1: Location of the hole in the custom-made 1-hole stent graft (arrow); B2: Fluoroscopy in the lateral view, showing balloon inflation in the celiac trunk from the stent graft hole (arrows); C1 & C2: Postprocedural computed tomography angiography, showing fenestrated endovascular aortic aneurysm repair with the exclusion of the pseudoaneurysm and the perfusion of the celiac trunk (arrows).

Figure 2

A1 & A2: Computed tomography angiography, showing a juxtarenal abdominal aortic aneurysm with a large right iliac aneurysm (white arrows); B1 & B2: Schematic location of the fenestrated custom-made stent graft with the iliac branch device; C1 & C2: Computed tomography angiography following fenestrated endovascular aortic aneurysm repair, showing the exclusion of the aneurysm and a patent right internal iliac artery branch (black arrow) and both renal arteries (white arrow).

Figure 3

A1 & A2: Abdominal computed tomography angiography, showing a juxtarenal aortic aneurysm (arrows); B1: Main body of the abdominal aortic stent graft; B2: Fluoroscopy, showing the cannulation of the holes of the custom-made fenestrated stent graft; C1: Digital subtraction angiography following fenestrated endovascular aortic aneurysm repair, showing the successful exclusion of the abdominal aorta aneurysm (arrow); C2: Digital subtraction angiography following fenestrated endovascular aortic aneurysm repair, showing patent iliac artery stent grafts (arrow).

Figure 4

A1 & A2: Computed tomography angiography, showing a thoracoabdominal aneurysm (arrows); B1: Location of the holes (arrows) in the custom-made 3-hole stent graft; B2: Fluoroscopy in the anterior posterior view, showing the successful cannulation from the 3 holes of the stent graft; C1 & C2: Digital subtraction angiography following fenestrated endovascular aortic aneurysm repair with the exclusion of the aneurysm (white arrows) and perfusion of the celiac artery, superior mesenteric artery, and both renal arteries (black arrows).