ENDOVASCULAR REPAIR OF THORACOABDOMINAL AND PARA-RENAL AORTIC ANEURYSMS WITH FENESTRATED AND BRANCHED STENT-GRAFTS

Abstract

Introdution: Aneurismal disease involving the thoracoabdominal segment adds significant complexity to endovascular aortic repair. Objective: Evaluate institutional experience of a tertiary center in fenestrated and branched aneurysm repair for throracoabdominal or juxtarenal aortic aneurysms Methods: Retrospective analysis of a consecutive series of patients treated by endovascular repair using fenestrated or branched stent grafts between October 2010 and May 2016. Results: Twenty-six patients underwent endovascular repair with fenestrated and/or branched stent grafts (mean age 68±7years; 1 female). Eleven patients had history of previous aortic intervention. Seventeen throracobdominal aneuryms had the following anatomic distribution: Type I: n=1; Type III: n=5; Type IV: n=6 and Type 5: n=5. Additionally nine pararenal aneuryms were treated. Mean maximum aneurym diameter was 72±25mm. There were 3 types of stent graft configuration based on aortic anatomy and aneurysm morphology: 21 custom-made (14 fenestrated and 7 fenestrated/branched) and 5 off-the-shelf multibranched (T-branch). The median number of fenestrations/branches per stent graft was 4(2-4). The total target visceral vessels involved was 88. In 88% another planned endovascular procedure was performed: EVAR n=15; TEVAR n=4 and EVAR+TEVAR n=4. The technical sucess rate was 96% (25/26) (1 case of ostial stenosis of the celiac trunk with unssucessfull catetherization). The 30 day mortality rate was 7,7% (2/26). Spinal cord ischemia occurred in 12% (N=3; acute onset N=1; delayed N=2) There was no difference between the pre- and post-operative (p=0,777). The mean follow-up time was 10±15 months. There were 2 endoleaks, and no late re-interventions nor late aneurismatic ruptures during the follow-up time. Conclusion: Fenestrated/branched devices development allowed the treatment of complex high risk aneurismatic disease in a less invasive manner. These procedures are technically demanding, but safe and effective in prevention of aneurysm rupture in our experience. Despite the relatively low number of patients, our results are in line with other international contemporary endovascular series.