Fenestrated Aortic Stent Grafts

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.

Fenestrated endovascular aneurysm repair

REFERENCES

• 1 Harris P L, Vallabhaneni S R, Desgranges P, Becquemin J-P, van Marrewijk C, Laheij R JF. for the EUROSTAR Collaborators . Incidence and risk factors of late rupture, conversion, and death after endovascular repair of infrarenal aortic aneurysms: The EUROSTAR experience.  J Vasc Surg. 2000;  32 739-749
• 2 Sampaio S M, Panneton J M, Mozes G I et al.. Proximal type I endoleak after endovascular abdominal aortic aneurysm repair: predictive factors.  Ann Vasc Surg. 2004;  18 621-628
• 3 West C A, Noel A A, Bower T C et al.. Factors affecting outcomes of open surgical repair of pararenal aortic aneurysms: a 10-year experience.  J Vasc Surg. 2006;  43 921-927 , discussion 927-928
• 4 Sarac T P, Clair D G, Hertzer N R et al.. Contemporary results of juxtarenal aneurysm repair.  J Vasc Surg. 2002;  36 1104-1111
• 5 Crawford E S, Beckett W C, Greer M S. Juxtarenal infrarenal abdominal aortic aneurysm: special diagnostic and therapeutic considerations.  Ann Surg. 1986;  203 661-670
• 6 Browne T F, Hartley D, Purchas S, Rosenberg M, Van Schie G, Lawrence-Brown M. A fenestrated covered suprarenal aortic stent.  Eur J Vasc Endovasc Surg. 1999;  18 445-449
• 7 Parodi J C, Palmaz J C, Barone H D. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms.  Ann Vasc Surg. 1991;  5 491-499
• 8 EVAR Trial Participants . Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomised controlled trial.  Lancet. 2005;  365 2187-2192
• 9 The United Kingdom Small Aneurysm Trial Participants . Long-term outcomes of immediate repair compared with surveillance of small abdominal aortic aneurysms.  N Engl J Med. 2002;  346 1445-1452
• 10 Instructions for Use: Zenith AAA Endovascular Graft with the H&L-B One-Shot Introduction System. Brisbane, Australia; William A Cook 2006
• 11 Adam D J, Berce M, Hartley D E, Anderson J L. Repair of juxtarenal paraanastomotic aortic aneurysms after previous open repair with fenestrated and branched endovascular stent grafts.  J Vasc Surg. 2005;  42 997-1001
• 12 Adam D J, Fitridge R A, Berce M, Hartley D E, Anderson J L. Salvage of failed prior endovascular abdominal aortic aneurysm repair with fenestrated endovascular stent grafts.  J Vasc Surg. 2006;  44 1341-1344
• 13 Verhoeven E LG, Muhs B E, Zeebregts C JAM et al.. Fenestrated and branched stent-grafting after previous surgery provides a good alternative to open redo surgery.  Eur J Vasc Endovasc Surg. 2007;  33 84-90
• 14 O'Neill S, Greenberg R K, Haddad F, Resch T, Sereika J, Katz E. A prospective analysis of fenestrated endovascular grafting: intermediate-term outcomes.  Eur J Vasc Endovasc Surg. 2006;  32 115-123
• 15 Haddad F, Greenberg R K, Walker E et al.. Fenestrated endovascular grafting: the renal side of the story.  J Vasc Surg. 2005;  41 181-190
• 16 Muhs B E, Verhoeven E LG, Zeebregts C J et al.. Mid-term results of endovascular aneurysm repair with branched and fenestrated endografts.  J Vasc Surg. 2006;  44 9-15
• 17 Semmens J B, Lawrence-Brown M MD, Hartley D E, Allen Y B, Green R, Nadkarni S. Outcomes of fenestrated endografts in the treatment of abdominal aortic aneurysm in Western Australia (1997-2004).  J Endovasc Ther. 2006;  13 320-329
• 18 Muhs B E, Teutelink A, Prokop M, Vincken K L, Moll F L, Verhagen H JM. Endovascular aneurysm repair alters renal artery movement: a preliminary evaluation using dynamic CTA.  J Endovasc Ther. 2006;  13 476-480
• 19 Muhs B E, Teutelink A, Verhoeven E LG et al.. Dynamic Cine-CTA Imaging of Standard versus Branched Endografts: Differing Effects on Renal Artery Motion with a Rationale for Routine Stenting of Fenestrations. Paper presented at: 60th Annual Meeting of the Society for Vascular Surgery June 4, 2006 Philadelphia, PA;
• 20 Sun Z, Mwipatayi B P, Semmens J B, Lawrence-Brown M MD. Short to midterm outcomes of fenestrated endovascular grafts in the treatment of abdominal aortic aneurysms: a systematic review.  J Endovasc Ther. 2006;  13 747-753