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THE JOURNAL OF CARDIOVASCULAR SURGERY
A Journal on Cardiac, Vascular and Thoracic Surgery
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632
The Journal of Cardiovascular Surgery 2015 Sep 29
The endovascular treatment of juxta-renal abdominal aortic aneurysm using fenestrated endograft: early and mid-term results
Gallitto E., Gargiulo M., Freyrie A., Mascoli C., Massoni Bianchini C., Ancetti S., Faggioli G., Stella A. ✉
Vascular Surgery, University of Bologna, Azienda Policlinico S. Orsola-Malpighi
AIM: To evaluate the early and mid term results of the endovascular treatment of juxta-renal abdominal aortic aneurysms (j-AAA) using fenestrated endograft (FEVAR).
METHODS: Between 2008 to 2013 all consecutive patients underwent FEVAR using Cook-Zenith fenestrated endograft for treating j-AAA (proximal neck length <5mm) with renal aortic α/β angle < 60°, were prospectively collected in a database. Cardiovascular risk factors, co-morbidities, aortic- iliac morphological features, intra and post-procedural data were analyzed. Pre-operative FEVAR planning was performed by a thoraco-abdominal computer tomography angiography (CTA) and the 3D/Center Lumen Line reconstructions (3Mensio). Follow-up was conduced by duplex ultrasound (DUS)/ contrast enhancement DUS (CEUS) and/or CTA at 1,6,12-month and yearly thereafter. Early endpoints were: technical (TS) / clinical (CS) success, renal function worsening (≥ 30% of pre- operative creatinine value) and type I/III endoleak. Mid term endpoints were: type I/III endoleak, target visceral vessels patency, j-AAA shrinkage, freedom from re-intervention and survival.
RESULTS: Twenty patients (M: 94.7%; mean age: 73.4±5.9 years; ASA ≥3: 100%) were enrolled. The mean neck length and j-AAA diameter were 2 ± 1.4mm (range: 0-4mm) and 54.9 ±5mm respectively. Eleven (55%) endograft with 2 fenestrations and a scallop, 8 (45%) with 3 fenestrations and a scallop and 1 (5%) with 1 fenestration and a scallop were implanted. Sixty-seven visceral vessels were re-vascularized. TS and CS were 100% and 95% respectively (1/20 30-day mortality). Peri-operative renal function worsening was observed in 15% of cases. The mean follow-up was 25±20 months (range: 2-72months). No type I/III endoleak or occlusion of target visceral vessels occurred. There was j-AAA shrinkage in 65% of patients and no cases of j-AAA enlargement were observed. There were no FEVAR-related re-interventions. Survival at 12, 24 and 36 months were 89.4%, 80.5% e 80.5% respectively.
CONCLUSION: According to our results, the endovascular treatment for j-AAA, with α/β angle < 60°, is safe and effective.