Ces radiol. 2011, 65(2):85-91

Endovascular therapy of juxtarenal abdominal aortic aneurysms by fenestrated stentgrafts - mid-term resultsOriginal article

Martin Köcher¹, Petr Utíkal², Marie Černá¹, Petr Bachleda², Jiří Kozák¹, Petr Dráč², Stanislav Buřval¹

¹ Radiologická klinika LF a FN, Olomouc

² II. chirurgická klinika LF a FN, Olomouc

Aim: Patients with proximal neck length ≤ 10 mm or ≤ 15 mm with a compromising morphology (funnel or thrombus) are nowadays indicated for implantation of fenestrated stentgraft due to higher risk of reintervention or rupture after implantation of conventional stentgraft. The aim of the study is to present our mid-term results of the treatment of juxtarenal abdominal aortic aneurysms by fenestrated stentgrafts.

Methods: From June 2002 to December 2010 18 patients (15 men, 3 women) with median age of 71.8 years (range 59-81 years) were indicated to treatment of juxtarenal abdominal aortic aneurysm by fenestrated stentgraft. The median abdominal aortic aneurysma diameter was 60 (range 44-98) mm. We used "home-made" stentgraft in 3 patients and "custom-made" Zenith Fenestrated AAA Endovascular Graft in 15 patients. Fenestrations were created on the basis of preoperative CT. We placed together 47 fenestrations (32 fenestrations and 15 scallops).

Results: Primary technical success was achieved in all patients, all fenestrations were successfully placed. Primary endoleak was not recorded. Perioperative mortality rate was 0%, perioperative morbidity 5%. The median duration of follow-up was 27 (range 3-72) months. Primary target vessel patency rate was 95.75%. Secondary endoleak was found at follow-up CT in four patients (1× endoleak Ib, 2× endoleak II, 1× endoleak IIIb). In one patient thrombosis stentgraft leg in one patient and occlusion of renal artery in 2 patients were found during the follow-up.

Conclusion: The treatment of juxtarenal abdominal aortic aneurysms by fenestrated stentgraft is effective with low risk of complications. In comparison to conventional endovascular abdominal aortic aneurysm treatment there is a higher risk of renal function deterioration especially in patients with preexisting renal impairment. The major disadvantage is cost of FSG.

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

Accepted: March 31, 2011; Published: June 1, 2011  Show citation