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A Journal on Vascular and Endovascular Surgery
Italian Journal of Vascular and Endovascular Surgery 2016 September;23(3):134-43
Home-made fenestrated endograft as urgent treatment of complex aortic aneurysms in high risk patients
Marco LEOPARDI 1, 2, Frederic COCHENNEC 1, Carlo SPARTERA 2, Jean-Pierre BECQUEMIN 1
1 Unit of Vascular and Endovascular Surgery, Henri Mondor Hospital, Créteil, France; 2 Department of Vascular Surgery, Università degli Studi di L’Aquila, L’Aquila, Italia
BACKGROUND: Physician modified fenestrated stent grafts (PMFSG) is one of the options to treat high risk patients presenting complex and thoraco abdominal aortic aneurysms. The aim of this study was to describe our technique to modify a standard aortic stent graft and report the our preliminary results.
METHODS: Consecutive patients treated with PMFSG between February 2006 and May 2013 in a tertiary Vascular Unit were included. Data were recorded by means of a prospectively collected database. Procedure planning and device sizing was performed using a dedicated 3D vascular imaging workstation. Follow-up and CT-scans were planned at one, six months and yearly.
RESULTS: During the study period, 162 patients underwent endovascular treatment of CAAA or TAAA. Eight among them were treated with PMFSG. The mean operatory time was 4.2 hours, the mean time to customize the endograft was 2.0±0.7 hours (1-3.5), mean fluoroscopy time 37.5 minutes, mean contrast used 113 mL. Technical success was achieved in 100% of cases and the mean in hospital stay was 16 days (4-30). The in-hospital mortality was 0%. We observed 3 procedure related complications: one spinal cord injury with transient paraplegia (12.5%), one type III endoleak from a renal branch (12.5%) and a cholesterol embolization syndrome (12.5%). 30-days mortality was 12.5% as one patient died for a multi organ failure. We observed no short term target vessel occlusion and no type I or II endoleaks on postoperative CT-scans. We observed no site-related complication and no other complications.
The mean follow-up was 3.3 months (1-9); during this period we observed no sac enlargements, rupture or conversion.
CONCLUSIONS: Physician modified fenestrated endografts are feasible and offer good early results. This technique must be limited in high risk patients presenting with complex aortic aneurysm in an emergent or semi urgent fashion. Long term follow-up are needed.