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Gallitto E., Gargiulo M., Freyrie A., Bianchini Massoni C., Mascoli C., Pini R., Faggioli G., Stella A.
Department of Vascular Surgery, Policlinico S. Orsola‑Malpighi, Bologna University, Bologna, Italy
AIM: The Fenestrated AnacondaTM endograft (Vascutek, Inchinnan, UK) is a new device that could be used to treat challenging aortic aneurysms involving the abdominal visceral vessels (AAA). In this single-centric report we analyze the perioperative and 6-month results of the Fenestrated AnacondaTM endograft for treating juxta- and pararenal AAA.
METHODS: Patients undergoing fenestrated endovascular aneurysm repair (FEVAR) using Fenestrated AnacondaTM endo graft between May 2012 and July 2013 were prospectively enrolled. Clinical, morphological, intra- and postoperative data were collected. FEVAR planning was performed on the computed tomography angiography (CTA) using dedicated software for advanced vessel analysis (3mensio Vascular, 3mensio Medical Imaging, Bilthoeven, The Netherlands). All patients performed a CTA and a contrast-enhanced ultrasound at 1 and 6 months. Endpoints were technical success (TS), perioperative and 6-month clinical success (CS), renal function worsening (creatinine ≥30% of preoperative value), visceral vessel patency and type I/III endoleaks.
RESULTS: Between May 2012 and July 2013, 5 patients (mean age 78.4±6.1 years, ASA III/IV: 4/1) underwent FEVAR using Fenestrated AnacondaTM endograft for juxtarenal (3 cases) and pararenal (2 cases) AAA. In 2 cases the neck angle was ≥45° and in 3 cases there was a severe iliac angle (≥60°). A total of 19 vessels were accommodated with 15 fenestrations (celiac trunk: 1; superior mesenteric arteries: 4; renal arteries: 10) and 4 valleys/scallops (celiac trunks: 3; superior mesenteric arteries: 1). In all cases the endograft was repositioned during the procedure and 6/19 visceral vessels were cannulated through left brachial access. TS was achieved in 4/5 patients (proximal type I endoleak). All the target visceral vessels were successfully treated. Thirty-day CS was 80% (transient renal function worsening). No permanent renal function worsening was recorded, all the visceral vessels treated were patent and no new onset of type I/III endoleaks was detected at 1 and 6 months.
CONCLUSION: The Fenestrated AnacondaTM endograft can be used to treat challenging aortic aneurysm involving the abdominal visceral vessels. Larger studies and long-term data are needed to confirm this treatment as safe and effective.