Fenestrated and Branched Stent-grafting After Previous Surgery Provides a Good Alternative to Open Redo Surgery

Abstract

Our report highlights the potential of fenestrated and branched technology to improve re-operative aortic surgical outcomes. The unique difficulties of increased graft on graft friction hindering placement, short working distance, and increased patient co-morbidities should be recognized.

Fenestrated and branched endograft repair of juxtarenal aneurysms after previous open aortic reconstruction

“…Previous reports from our institution and others 1,[3][4][5]17 have demonstrated that primary aneurysms involving the visceral segment of the aorta can successfully be managed with totally endovascular procedures with good outcomes. Because both our short and long-term results have been excellent with this method of repair, we prefer to repair all juxtarenal aneurysms by endovascular means, even in good operative risk patients.…”

“…The technique for endograft deployment has been described in detail previously. 2,4,6,7 Briefly, open femoral artery exposure was performed on one or both sides depending on the number of fenestrations and type of visceral revascularization planned. Axillary artery cut-down was used when a caudally-oriented directional graft branch was used for branch vessel revascularization.…”

“…[12][13][14][15] We have previously reported our early results with fenestrated and branched endografting in a heterogeneous group of patients with previous open and endovascular aortic reconstructions. 4 Although we now preferentially repair all juxtarenal aneurysms using endovascular means, we have identified specific difficulties associated with the management of patients after a prior open aneurysm repair.…”

“…Use of these devices is becoming increasingly prevalent, and clinical outcomes with the technology have been demonstrated to be quite good. [1][2][3][4][5] Anastomotic pseudo-aneurysms and aneurysmal degeneration of the aorta after open infrarenal aneurysm repair poses a difficult clinical problem, especially in highrisk patients. Repair of anastomotic aneurysms can sometimes be managed using a standard infrarenal endograft, 6 but often the aneurysm encroaches on the visceral vessels such that it could traditionally only be repaired by either open means or a hybrid open and endovascular repair.…”

Endovascular Treatment of Thoracoabdominal Aneurysm

“…Modular grafts are extended from an area of normal-caliber aorta in the descending thoracic aorta to a landing zone distally in either the infrarenal aorta or the bilateral iliac arteries. When there is arch involvement, it often [38] 1 1 3 2 7 Button and Jenkins [39] 1 5 0 0 Verhoeven et al [36] 3 0 2 7 [42] 90.7 19 Muhs et al [40] 9 2 4 6 Ziegler et al [43] 92.2 72 Scurr et al [44] 96.6 24 Kristmundsson et al [45] 9 6 2 5 is necessary to first perform open arch replacement using the elephant trunk procedure to provide an area in the proximal descending aorta of suitable caliber to provide a landing zone for the stent graft. Once the graft is deployed, branch vessels are cannulated through it (either through the fenestrations or the branches) and combined with small balloon-expandable covered stents to accommodate visceral arteries.…”