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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Italian Journal of Vascular and Endovascular Surgery 2016 September;23(3):129-33
Fenestrated AnacondaTM endograft for juxta/para-renal aortic aneurysms. Preliminary Italian multi-center experience
Enrico GALLITTO, Antonio FREYRIE, Mauro GARGIULO, Gianluca FAGGIOLI, Andrea STELLA
Department of Vascular Surgery, Alma Mater Studiorum, Bologna University, S. Orsola-Malpighi Policlinic, Bologna, Italy
BACKGROUND: The AnacondaTM Fenestrated endograft (Vascutek, Inchinnan, UK) is a new device that could be used to treat challenging aortic aneurysms (AAA) involving the abdominal visceral vessels. The aim of the present study was to report the preliminary results of the Italian multi-centers experience.
METHODS: Patients undergone fenestrated endovascular aneurysm repair (FEVAR) using AnacondaTM Fenestrated endograft, between May 2012 and November 2014, were prospectively enrolled. Clinical, morphological, intra and postoperative data were collected. Indications for FEVAR included AAA with proximal neck unsuitable for standard EVAR. Planning was performed on the computed tomography angiography using dedicated software for the advanced vessels analysis. Primary endpoints were technical success (TS) and 30-day clinical success (CS). Secondary endpoints were: adverse events (type I/III endoleaks, target visceral vessels occlusion)/reinterventions FEVAR-related and AAA-related mortality during the follow-up.
RESULTS: Twenty-six patients (male, mean age 74±7years, ASAIII/IV:16/10) underwent FEVAR using AnacondaTM Fenestrated endograft in 11 Italian Vascular Surgery Units for 5 short neck AAA and 21 juxta/para-renal AAA. An overall of 67 target visceral vessels were accommodated by using of fenestrations. Fenestrated endograft with 1, 2, 3 and 4 fenestrations were used in 1, 10, 14 and 1 cases, respectively. A bifurcated and tube endograft was planned in 23 and 3 cases, respectively. In 17/26 (65%) cases the endograft was repositioned during the procedure and in 14/26 (54%) cases almost 1 target visceral vessel was cannulated from the brachial access. TS was achieved in 24/26 (92%) patients (2 type I endoleak). All the target visceral vessels were successfully cannulated and stented. An occlusion of 1 renal artery and 1 type III endoleak (between the aortic endograft and renal artery stent-graft) occurred within the first week. The 30-day mortality was 7.7% (2/26). The 30-day CS was 80%. The mean follow-up was 12 months (range:1-33). No type I/III endoleaks and target visceral vessels occlusion occurred during the follow-up. There were not re-interventions FEVAR-related and AAA-related mortality.
CONCLUSIONS: The AnacondaTM Fenestrated endograft can be used to treat challenging AAA involving the abdominal visceral vessels. Larger experiences and long-term data are mandatory to confirm this treatment as safe and effective also in the mid and long term follow-up.