ORIGINAL ARTICLE  VASCULAR SECTION 

The Journal of Cardiovascular Surgery 2019 April;60(2):237-44

DOI: 10.23736/S0021-9509.16.09049-2

Copyright © 2015 EDIZIONI MINERVA MEDICA

language: English

The endovascular treatment of juxta-renal abdominal aortic aneurysm using fenestrated endograft: early and mid-term results

Enrico GALLITTO ✉, Mauro GARGIULO, Antonio FREYRIE, Chiara MASCOLI, Claudio MASSONI BIANCHINI, Stefano ANCETTI, Gianluca FAGGIOLI, Andrea STELLA

Division of Vascular Surgery, University of Bologna, S. Orsola-Malpighi Polyclinic Hospital, Bologna, Italy

BACKGROUND: The aim of the present study was 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 <5 mm) with renal aortic α/β angle <60°, were prospectively collected in a database. Cardiovascular risk factors, comorbidities, aortic-iliac morphological features, intra and post-procedural data were analyzed. Preoperative FEVAR planning was performed by a thoraco-abdominal computer tomography angiography (CTA) and the 3D/Center Lumen Line reconstructions (3mensio Medical Imaging, Bilthoven, The Netherlands). Follow-up was conducted by duplex ultrasound (DUS)/ contrast enhancement DUS (CEUS) and/or CTA at 1, 6, and 12 months, and yearly thereafter. Early endpoints were technical (TS) and clinical success (CS), renal function worsening (≥30% of preoperative creatinine value) and type I/III endoleak. Mid-term endpoints were: type I/III endoleak, target visceral vessels patency, j-AAA shrinkage, freedom from reintervention and survival.
RESULTS: Twenty patients (94.7% of whom male; mean age: 73.4±5.9 years; ASA≥3: 100%) were enrolled. The mean neck length and j-AAA diameter were 2±1.4 mm (range: 0-4 mm) and 54.9±5 mm, respectively. Eleven (55%) endograft with two fenestrations and a scallop, 8 (45%) with three fenestrations and a scallop, and one (5%) with one 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). Perioperative renal function worsening was observed in 15% of cases. The mean follow-up was 25±20 months (range: 2-72 months). 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 reinterventions. Survival at 12, 24, and 36 months were 89.4%, 80.5%, and 80.5%, respectively.
CONCLUSIONS: According to our results, the endovascular treatment for j-AAA, with α/β angle <60°, is safe and effective.

KEY WORDS: Abdominal aortic aneurysm - Vascular grafting - Stents - Endovascular procedures