REVIEW  FEVAR FOR JUXTARENAL RECONSTRUCTION 

The Journal of Cardiovascular Surgery 2020 February;61(1):10-7

DOI: 10.23736/S0021-9509.19.11181-0

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

FEVAR/BEVAR have limitations and do not always represent the preferred option for juxtarenal reconstruction

Vincent RIAMBAU ¹ ✉, Carla BLANCO AMIL ¹, Laura CAPOCCIA ², Gaspar MESTRES ¹, Xavier YUGUEROS ¹

¹ Division of Vascular Surgery, Cardiovascular Institute, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain; ² Division Vascular and Endovascular Surgery, “Paride Stefanini” Department of Surgery, Umberto I Plyclinic, Sapienza University, Rome, Italy

Following the definition given by the recent ESVS guidelines, juxtarenal abdominal aortic aneurysm (JAAA) is defined as an aneurysm extending up to but not involving the renal arteries, necessitating suprarenal aortic clamping for open surgery, i.e. a short neck (<10 mm). JAAA repair always represents a challenge intervention, either by open or endovascular means, mostly related to the renal arteries involvement. Concerning endovascular repair, different options can be considered. Among them, fenestrated endografts (FEVAR) should be considered as a first option1, due to their reported safety and efficacy. However, when the anatomy is not favorable or when FEVAR devices are not available in an emergency setting for instance, other alternatives can be considered like parallel graft or chimney technique (ChEVAR). Do nothing is the last alternative when medical and anatomical circumstances are absolutely poor. In the following pages, we will review the limitations of FEVAR and branched endografts, the better indications and anatomical conditions for a successful repair with ChEVAR technique and its current clinical results reported in the literature.

KEY WORDS: Aortic aneurysm, abdominal; Renal artery; Endovascular procedures