Document Detail


Treatment of short-necked infrarenal aortic aneurysms with fenestrated stent-grafts: short-term results.
MedLine Citation:
PMID:  15079769     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: A proximal neck of 15 mm length is usually required to allow endovascular repair of abdominal aortic aneurysms (EVAR). Many patients have been refused EVAR due to a short neck. By customising fenestrated grafts to the patients' anatomy, we can offer an endovascular solution, especially for patients who are unsuitable for open repair. METHODS: Eighteen patients were selected for fenestrated stent-grafting if they presented with an abdominal aneurysm of at least 55 mm in diameter, a short neck (less than 15 mm), plus contra-indications for open repair (cardiopulmonary impairment or a hostile abdomen). The stent-graft used was a customised fenestrated model based on the Cook Zenith composite system. We used additional stents to ensure apposition of the fenestrations with the side branches. RESULTS: All endovascular procedures were successful. Out of the 46 targeted side branches (10 superior mesenteric arteries, 36 renal arteries), 45 were patent at the end of the procedure. One accessory renal artery became occluded by the stent-graft. There was one possible proximal type I endoleak, which later proved to be a type II endoleak. There was no mortality, but complications occurred in six patients: two cardiac complications, three urinary complications and one occlusion of a renal artery. At follow-up (mean 9.4 months, range 1-18), there were no additional renal complications and all the remaining targeted vessels stayed patent. DISCUSSION: By customizing fenestrated stent-grafts, it is possible to position the first covered stent completely inside the proximal neck, thus achieving a more stable position. The additional side-stents may also contribute to a better fixation. This technique may become a valuable alternative for patients who are at high risk from open surgery.
Authors:
E L G Verhoeven; T R Prins; I F J Tielliu; J J A M van den Dungen; C J A M Zeebregts; R G Hulsebos; M G van Andringa de Kempenaer; M Oudkerk; R van Schilfgaarde
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery     Volume:  27     ISSN:  1078-5884     ISO Abbreviation:  Eur J Vasc Endovasc Surg     Publication Date:  2004 May 
Date Detail:
Created Date:  2004-04-13     Completed Date:  2004-06-10     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9512728     Medline TA:  Eur J Vasc Endovasc Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  477-83     Citation Subset:  IM    
Affiliation:
Department of Surgery, University Hospital of Groningen, Hanzeplein 1, P.O.Box 30.001, 9700 RB, Groningen, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal / surgery*
Blood Vessel Prosthesis Implantation*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Postoperative Complications
Prosthesis Design
Renal Artery / surgery
Stents
Treatment Outcome
Comments/Corrections
Comment In:
Eur J Vasc Endovasc Surg. 2004 May;27(5):453-5   [PMID:  15079766 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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