Early and Mid-term Efficacy of Fenestrated Endograft in the Treatment of Juxta-Renal Aortic Aneurysms

Gallitto, Enrico; Faggioli, Gianluca; Giordano, Jacopo; Pini, Rodolfo; Mascoli, Chiara; Fenelli, Cecilia; Abualhin, Mohammad; Ancetti, Stefano; Logiacco, Antonino; Gargiulo, Mauro

doi:10.1016/j.avsg.2019.10.077

Cited by 13 publications

(16 citation statements)

References 22 publications

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“…1 According with these inclusion criteria, we identified 129 (9%) JAAAs in a series of 1452 aortic aneurysm repairs, quite similar to an overall incidence of 5-15% of all aortic aneurysm reported in previous literature experiences. 1,[3][4][5][11][12][13] Unfortunately, due to the unavailability of complete preoperative CTA, about 20% of these cases was excluded from the study analysis.…”

Section: Discussionmentioning

confidence: 99%

“…In our previous clinical experience, only 36% of JAAAs received an endograft with ≤ 2 fenestrations 3 ; 64% of cases required fenestration and stenting for the superior mesenteric artery and 23% for the celiac trunk. 3 It is theoretically associated with a possible higher rate of bowel or spinal cord ischemic complications than open repair. Even if no cases of early bowel ischemia or splanchnic complications occurred in our previous series, 3 nevertheless this aspect requires confirm also during a longer follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…As regards the planning of the custom made FEVAR devices, a safe/effective proximal sealing zone was evaluated measuring at least 2 cm length of healthy aortic wall (regular cylindrical shape-with no posterior bulging). 3 In this segment a circumferential apposition between endograft and aortic wall was required (no scallop design in these 2 cm) and the main-body oversize was calculated about 20%. 3 Target visceral vessels (TVVs) were analyzed at the preoperative CTA (diameter and main trunk length) in order to preoperatively select the length and diameter of balloon expandable bridging stents-graft.…”

Section: Methodsmentioning

confidence: 99%

“…3 In this segment a circumferential apposition between endograft and aortic wall was required (no scallop design in these 2 cm) and the main-body oversize was calculated about 20%. 3 Target visceral vessels (TVVs) were analyzed at the preoperative CTA (diameter and main trunk length) in order to preoperatively select the length and diameter of balloon expandable bridging stents-graft. 3 As reported in our previous reports, hostile iliac artery anatomy (HIA) was defined as at least one of the following features: severe (>90°) iliac angle, extensive (>50%) iliac circumferential calcification, hemodynamic iliac stenosis/ obstruction, external iliac artery diameter <7 mm, previous aorto-iliac/femoral surgical or endovascular graft.…”

Section: Methodsmentioning

confidence: 99%

“…Endovascular repair of juxta-renal aortic aneurysms (JAAAs) is currently a safe and effective therapeutic option, especially in patients at high surgical risk. [1][2][3][4][5][6] Available techniques include fenestrated endograft (FEVAR), parallel graft technique (CHEVAR), and endo-anchors (ESAR) 1,2 (Figures 1 to 3). According with the European Society for Vascular Surgery (ESVS) Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms, the FEVAR repair should be considered the preferred endovascular option when feasible, while CHEVAR may be considered as an alternative in the emergency setting or when fenestrated stentgrafts are not indicated/available, or as a bailout and ideally restricted to ≤ 2 chimneys.…”

Section: Introductionmentioning

confidence: 99%

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Anatomical feasibility of the current endovascular solutions for Juxtarenal aortic abdominal aneurysm repair

et al. 2022

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Purpose Endovascular repair of juxta-renal aneurysms (JAAAs) can be achieved by fenestrated endografts (FEVAR), parallel-grafts (CHEVAR) and standard abdominal endografts + endoanchors (ESAR). Aim of this study was to evaluate the incidence of their anatomical feasibility in JAAAs. Materials and Methods All patients submitted to JAAAs treatment from 2006 to 2019 were retrospectively analyzed, irrelevant of the procedure performed. Juxta-renal aneurysm was defined according with the current ESVS clinical practice guidelines. Preoperative computed tomography angiographies were analyzed to evaluate the anatomical feasibility of: FEVAR (Cook Zenith-platform; CE-marked or custom-made device), CHEVAR (Medtronic Endurant + Atrium Advanta - CE marked combination) and ESAR (Medtronic Endurant + Helifix - CE marked combination) according with the manufactures’ instruction for use. The anatomical feasibility of these three endovascular solutions was assessed according with the proximal neck, target visceral vessels (TVVS) and iliac access characteristics. Results Ninety-nine cases were considered. There were no cases of frank aortic rupture and in all patients at least one arterial access from above was available. Fenestrated endograft, CHEVAR, and ESAR were anatomically feasible in 93 (94%), 37 (37%), and 27 (27%) cases, respectively ( p <. 001). Fenestrated endograft requires design with <3, three and >3 fenestrations in 29 (31%), 33 (36%), and 31 (33%) cases, respectively. Parallel graft technique have required 1 or 2 parallel graft configurations in 12 (12%) and 25 (25%) cases, respectively. Among the 14 cases with aneurysm diameter >70 mm, the anatomical feasibility of FEVAR, CHEVAR, and ESAR was 13(93%), 4(29%), and 4 (29%) cases, respectively ( p < .001). Conclusion Fenestrated endograft is more frequently applicable than CHEVAR and ESAR as endovascular treatment of JAAAs. Since this difference is valid also in aneurysms with diameter >70 mm, the issue of a rapid availability is of paramount importance. The 6% of cases have not any endovascular solution and requires open surgery.

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