Treatment of complex aortic aneurysms with fenestrated endografts and chimney stent repair: Systematic review and meta-analysis

Abstract

Objective We reviewed data pertaining to fenestrated endograft technique and chimney stent repair of complex aortic aneurysm for comparative analysis of the outcomes. Methods A comprehensive search of relevant databases was conducted to identify articles in English, related to the treatment of complex aortic aneurysm with fenestrated endovascular aneurysm repair and chimney stent repair, published until January 2015. Results A total of 42 relevant studies and 2264 patients with aortic aneurysm undergoing fenestrated endovascular aneurysm repair and chimney stent repair were included in our review. A total of 4413 vessels were involved in these processes. The cumulative 30-day mortality was 2.4% and 3.2% ( p = 0.459). The follow-up aneurysm-related mortality was 1.4% and 3.2% ( p = 0.018), and target organ dysfunction was 5.0% and 4.0% in fenestrated endovascular aneurysm repair and chimney stent repair, respectively ( p = 0.27). A total of 156 vessels showed restenosis or occlusion after primary intervention (3.6% and 3.4% in fenestrated endovascular aneurysm repair and chimney stent repair, respectively, p = 0.792). The cumulative type I endoleak was 2.0% (38/1884) after fenestrated endovascular aneurysm repair compared with 3.4% (13/380) after chimney stent repair ( p = 0.092), and the type II endoleak was 5.4% (102/1884) and 5.3% (20/380), respectively ( p = 0.905). Approximately, 1.1% and 1.6% increase in aneurysm was observed following fenestrated endovascular aneurysm repair and chimney stent repair, respectively ( p = 0.437). The re-intervention frequency was 205 and 19 cases after fenestrated endovascular aneurysm repair and chimney stent repair, respectively (11.7%, 5.6%, p = 0.001). Conclusions Fenestrated endovascular aneurysm repair and chimney stent repair are safe and effective in treating patients with complex aortic aneurysm. A higher aneurysm-related mortality was observed in chimney stent repair while fenestrated endovascular aneurysm repair was associated with a higher re-intervention rate.

Comparison of Fluid Dynamics Variations Between Chimney and Fenestrated Endografts for Pararenal Aneurysms Repair: A Patient Specific Computational Study as Motivation for Clinical Decision-Making

“…2 A recent meta-analysis attempted to compare the vessel patency after treatment of complex aortic aneurysms between fenestrated endografts and chimney stent repair. 3 A total of 2264 patients with complex aortic aneurysms undergoing fenestrated or chimney graft repair were included in this study, analyzing a total of 4413 vessels. The study showed comparative restenosis or occlusion after primary intervention between the 2 techniques (3.6% in fenestrated vs 3.4% in chimney, P = .792).…”

“…1,2 A recently reported meta-analysis, attempting to compare the outcomes between the 2 techniques regarding the treatment of complex aortic cases, showed that a higher aneurysm-related mortality was observed in chimney stent repair, while fenestrated EVAR was associated with a higher reintervention rate. 3 –5…”

Proximal fixation devices in endovascular repair of abdominal aortic aneyrysm with unfavourable proximal neck anatomy

“…Метаанализ, включивший сведения об имплантации 1884 фенестрированных и 380 параллельных графтов у пациентов с АБА, не пригодной для стандартного эндопротезирования, показал следующие результаты. Общая частота повторных вмешательств в группе фенестрированных графтов составила 11,7%, эндолик IА типа развился в 2% случаев, рестеноз/окклюзия в стентированных ветвях -в 3,6% случаев; в группе параллельных графтов общая частота повторных вмешательств составила 5,6%, эндолик I типа развился в 3,4% случаев, рестеноз/окклюзия в стентированных ветвях -в 3,4% [23].…”

Repair of abdominal aortic aneurysms: preoperative imaging and evaluation

“…Fenestrated and branched endografts, are endografts with openings and side branches arising directly from the graft and include the visceral artery with the endograft. Recent data suggest that fenestrated and branched endograft placement results in relatively safe, effective, and durable outcomes in highsurgical risk patients treated for complex aortic aneurysms (17,18,44,54,55). As complex EVAR experience and use with branched and fenestrated endografts continue to grow preoperative imaging for endograft customization becomes increasingly important.…”