Juxtarenal endovascular therapy with fenestrated and branched stent grafts after previous infrarenal repair
Sveinsson, Magnus LU ; Kristmundsson, Thorarinn LU ; Dias, Nuno LU
; Sonesson, Bjorn
LU
; Mani, Kevin
; Wanhainen, Anders
and Resch, Timothy
LU
(2019)
In Journal of Vascular Surgery
- Abstract
Background: The treatment strategy for proximal aortic disease or type I endoleak after previous infrarenal repair has traditionally been open surgery. As endovascular treatment options with fenestrated and branched stent grafts increasingly rival open surgery for juxtarenal and pararenal aortic aneurysms, secondary proximal repair may similarly be performed endovascularly. Fenestrated stent grafts are individually tailored to each patient, whereas a more readily available “off-the-shelf” branched stent graft is often suitable in more urgent settings. Methods: All patients who had been reoperated on with a proximal fenestrated or branched cuff after previous infrarenal endovascular or open repair from two tertiary referral centers... (More)
Background: The treatment strategy for proximal aortic disease or type I endoleak after previous infrarenal repair has traditionally been open surgery. As endovascular treatment options with fenestrated and branched stent grafts increasingly rival open surgery for juxtarenal and pararenal aortic aneurysms, secondary proximal repair may similarly be performed endovascularly. Fenestrated stent grafts are individually tailored to each patient, whereas a more readily available “off-the-shelf” branched stent graft is often suitable in more urgent settings. Methods: All patients who had been reoperated on with a proximal fenestrated or branched cuff after previous infrarenal endovascular or open repair from two tertiary referral centers between 2002 and 2015 were included in the analysis. Patients were retrospectively enrolled in a digital database. Data were collected from chart review and digital imaging. Results: There were 43 patients, 37 (86%) male and six (14%) female, who were treated. The indications for proximal endovascular repair were type I endoleak (58%), proximal aneurysm formation (30%), and stent graft migration (12%). Median follow-up time was 33 months (range, 3-120 months); 34 patients (79%) received a fenestrated cuff, and branched stent grafts were used in 8 (19%) cases. The majority of grafts had three (47%) or four (49%) fenestrations or branches. Technical success was accomplished in 93% of cases. In two cases, the celiac trunk occluded; in one case, the hepatic artery was overstented, and a renal artery could not be cannulated in one case. Median hospital stay was 5 days (range, 2-57 days). The 30-day mortality was 0%, and 1-year mortality was 5%. One patient died of an aneurysm-related cause during the study period. Conclusions: An endovascular approach with fenestrated or branched stent grafts for treatment of proximal endoleak, proximal aneurysm formation, or pseudoaneurysms after previous infrarenal repair seems to be a valid alternative to open surgery.
(Less)
- author
- Sveinsson, Magnus
LU
; Kristmundsson, Thorarinn
LU
; Dias, Nuno
LU
; Sonesson, Bjorn
LU
; Mani, Kevin
; Wanhainen, Anders
and Resch, Timothy
LU
- organization
- publishing date
- 2019-07-18
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Branched, Cuff, Fenestrated, FEVAR
- in
- Journal of Vascular Surgery
- publisher
- Mosby-Elsevier
- external identifiers
-
- scopus:85069430310
- pmid:31327608
- ISSN
- 0741-5214
- DOI
- 10.1016/j.jvs.2019.01.078
- language
- English
- LU publication?
- yes
- id
- fd05103a-1e78-470e-98df-4ece8a255ef1
- date added to LUP
- 2019-08-09 11:37:59
- date last changed
- 2024-04-30 18:54:22
@article{fd05103a-1e78-470e-98df-4ece8a255ef1,
abstract = {{<p>Background: The treatment strategy for proximal aortic disease or type I endoleak after previous infrarenal repair has traditionally been open surgery. As endovascular treatment options with fenestrated and branched stent grafts increasingly rival open surgery for juxtarenal and pararenal aortic aneurysms, secondary proximal repair may similarly be performed endovascularly. Fenestrated stent grafts are individually tailored to each patient, whereas a more readily available “off-the-shelf” branched stent graft is often suitable in more urgent settings. Methods: All patients who had been reoperated on with a proximal fenestrated or branched cuff after previous infrarenal endovascular or open repair from two tertiary referral centers between 2002 and 2015 were included in the analysis. Patients were retrospectively enrolled in a digital database. Data were collected from chart review and digital imaging. Results: There were 43 patients, 37 (86%) male and six (14%) female, who were treated. The indications for proximal endovascular repair were type I endoleak (58%), proximal aneurysm formation (30%), and stent graft migration (12%). Median follow-up time was 33 months (range, 3-120 months); 34 patients (79%) received a fenestrated cuff, and branched stent grafts were used in 8 (19%) cases. The majority of grafts had three (47%) or four (49%) fenestrations or branches. Technical success was accomplished in 93% of cases. In two cases, the celiac trunk occluded; in one case, the hepatic artery was overstented, and a renal artery could not be cannulated in one case. Median hospital stay was 5 days (range, 2-57 days). The 30-day mortality was 0%, and 1-year mortality was 5%. One patient died of an aneurysm-related cause during the study period. Conclusions: An endovascular approach with fenestrated or branched stent grafts for treatment of proximal endoleak, proximal aneurysm formation, or pseudoaneurysms after previous infrarenal repair seems to be a valid alternative to open surgery.</p>}},
author = {{Sveinsson, Magnus and Kristmundsson, Thorarinn and Dias, Nuno and Sonesson, Bjorn and Mani, Kevin and Wanhainen, Anders and Resch, Timothy}},
issn = {{0741-5214}},
keywords = {{Branched; Cuff; Fenestrated; FEVAR}},
language = {{eng}},
month = {{07}},
publisher = {{Mosby-Elsevier}},
series = {{Journal of Vascular Surgery}},
title = {{Juxtarenal endovascular therapy with fenestrated and branched stent grafts after previous infrarenal repair}},
url = {{http://dx.doi.org/10.1016/j.jvs.2019.01.078}},
doi = {{10.1016/j.jvs.2019.01.078}},
year = {{2019}},
}