TY - JOUR
T1 - Juxtarenal endovascular therapy with fenestrated and branched stent grafts after previous infrarenal repair
AU - Sveinsson, Magnus
AU - Kristmundsson, Thorarinn
AU - Dias, Nuno
AU - Sonesson, Bjorn
AU - Mani, Kevin
AU - Wanhainen, Anders
AU - Resch, Timothy
N1 - Copyright © 2019 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.
PY - 2019/12
Y1 - 2019/12
N2 - BACKGROUND: The treatment strategy for proximal aortic disease or type I endoleak after previous infrarenal repair has traditionally been open surgery. As endovascular treatment options with fenestrated and branched stent grafts increasingly rival open surgery for juxtarenal and pararenal aortic aneurysms, secondary proximal repair may similarly be performed endovascularly. Fenestrated stent grafts are individually tailored to each patient, whereas a more readily available "off-the-shelf" branched stent graft is often suitable in more urgent settings.METHODS: All patients who had been reoperated on with a proximal fenestrated or branched cuff after previous infrarenal endovascular or open repair from two tertiary referral centers between 2002 and 2015 were included in the analysis. Patients were retrospectively enrolled in a digital database. Data were collected from chart review and digital imaging.RESULTS: There were 43 patients, 37 (86%) male and six (14%) female, who were treated. The indications for proximal endovascular repair were type I endoleak (58%), proximal aneurysm formation (30%), and stent graft migration (12%). Median follow-up time was 33 months (range, 3-120 months); 34 patients (79%) received a fenestrated cuff, and branched stent grafts were used in 8 (19%) cases. The majority of grafts had three (47%) or four (49%) fenestrations or branches. Technical success was accomplished in 93% of cases. In two cases, the celiac trunk occluded; in one case, the hepatic artery was overstented, and a renal artery could not be cannulated in one case. Median hospital stay was 5 days (range, 2-57 days). The 30-day mortality was 0%, and 1-year mortality was 5%. One patient died of an aneurysm-related cause during the study period.CONCLUSIONS: An endovascular approach with fenestrated or branched stent grafts for treatment of proximal endoleak, proximal aneurysm formation, or pseudoaneurysms after previous infrarenal repair seems to be a valid alternative to open surgery.
AB - BACKGROUND: The treatment strategy for proximal aortic disease or type I endoleak after previous infrarenal repair has traditionally been open surgery. As endovascular treatment options with fenestrated and branched stent grafts increasingly rival open surgery for juxtarenal and pararenal aortic aneurysms, secondary proximal repair may similarly be performed endovascularly. Fenestrated stent grafts are individually tailored to each patient, whereas a more readily available "off-the-shelf" branched stent graft is often suitable in more urgent settings.METHODS: All patients who had been reoperated on with a proximal fenestrated or branched cuff after previous infrarenal endovascular or open repair from two tertiary referral centers between 2002 and 2015 were included in the analysis. Patients were retrospectively enrolled in a digital database. Data were collected from chart review and digital imaging.RESULTS: There were 43 patients, 37 (86%) male and six (14%) female, who were treated. The indications for proximal endovascular repair were type I endoleak (58%), proximal aneurysm formation (30%), and stent graft migration (12%). Median follow-up time was 33 months (range, 3-120 months); 34 patients (79%) received a fenestrated cuff, and branched stent grafts were used in 8 (19%) cases. The majority of grafts had three (47%) or four (49%) fenestrations or branches. Technical success was accomplished in 93% of cases. In two cases, the celiac trunk occluded; in one case, the hepatic artery was overstented, and a renal artery could not be cannulated in one case. Median hospital stay was 5 days (range, 2-57 days). The 30-day mortality was 0%, and 1-year mortality was 5%. One patient died of an aneurysm-related cause during the study period.CONCLUSIONS: An endovascular approach with fenestrated or branched stent grafts for treatment of proximal endoleak, proximal aneurysm formation, or pseudoaneurysms after previous infrarenal repair seems to be a valid alternative to open surgery.
KW - Aged
KW - Aged, 80 and over
KW - Aortic Aneurysm/surgery
KW - Endoleak/surgery
KW - Endovascular Procedures/methods
KW - Female
KW - Foreign-Body Migration/surgery
KW - Humans
KW - Male
KW - Middle Aged
KW - Postoperative Complications/etiology
KW - Reoperation
KW - Retrospective Studies
KW - Stents/adverse effects
U2 - 10.1016/j.jvs.2019.01.078
DO - 10.1016/j.jvs.2019.01.078
M3 - Journal article
C2 - 31327608
SN - 0741-5214
VL - 70
SP - 1747
EP - 1753
JO - Journal of Vascular Surgery
JF - Journal of Vascular Surgery
IS - 6
ER -