Ces radiol. 2007, 61(2):146-152

Endovascular treatment of juxtarenal abdominal aortic aneurysms by fenestrated stentgrafts: short-term resultsOriginal article

Martin Köcher¹, Petr Utíkal², Marie Černá¹, Petr Bachleda², Petr Dráč², Jiřina Koutná³

¹ Radiologická klinika LF a FN, Olomouc

² II. chirurgická klinika LF a FN, Olomouc

³ Klinika anestezie a resuscitace, LF a FN, Olomouc

Aim: The basic requirement for endovascular abdominal aortic repair is suitable morphology of the aneurysm and iliac arteries. The most critical parameters for endovascular treatment are the length of proximal neck of the aneurysm and the angle formed between the longitudinal axis of the aneurysm and the longitudinal axis of the aneurysmal neck. The aim of our article is to describe indications and technique of juxtarenal abdominal aortic aneurysm treatment by using fenestrated stentgrafts and to present our initial experience and short-term results.

Method: Fenestrated stentgraft is indicated in aneurysms with proximal neck shorter than 10 mm or shorter than 15 mm with funnel shape or extensive thrombus. According to these criteria, six patients were indicated for abdominal aortic aneurysm repair by means of fenestrated stentgraft. We used "home-made" stentgraft in three patients and "custom-made" stentgraft in three patients. Fenestrations were created on the basis of pre-operative CT.

Results: Primary technical success was achieved in all six patients, fenestrations were successfully placed in all cases. We placed altogether 14 fenestrations for 11 renal arteries and three superior mesenteric arteries. Primary endoleak was not encountered. Secondary endoleak (type IIIb) was found at follow-up CT in one patient. In one patient, thrombosis of the renal artery was found during the first year of follow-up.

Conclusion: The treatment of juxtarenal abdominal aortic aneurysms by fenestrated stentgraft is technically feasible. This technique improves proximal stentgraft fixation, reduces risk of migration as well as of proximal perigraft endoleak, and extends indications for endovascular aortic repair.

Keywords: abdominal aortic aneurysm, endovascular therapy, fenestrated stentgraft, juxtarenal aneurysm

Accepted: April 15, 2007; Published: June 1, 2007  Show citation