Fenestrated and branched endograft repair of juxtarenal aneurysms after previous open aortic reconstruction
| Autor: | Adam W. Beck, Eric L.G. Verhoeven, G. Vourliotakis, Ignace F.J. Tielliu, Clark J. Zeebregts, W. T. G. J. Bos |
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| Přispěvatelé: | Man, Biomaterials and Microbes (MBM), Vascular Ageing Programme (VAP) |
| Rok vydání: | 2009 |
| Předmět: |
Male
Reoperation medicine.medical_specialty Aortography Time Factors medicine.medical_treatment Aortic Diseases Blood Loss Surgical Prosthesis Design Aortic aneurysm Blood Vessel Prosthesis Implantation Blood vessel prosthesis medicine.artery Open aortic surgery medicine Humans Surgical Wound Infection Aged Aged 80 and over Heart Failure Aorta medicine.diagnostic_test Groin BIFURCATION business.industry Anastomosis Surgical Stent ENDOVASCULAR REPAIR Perioperative Middle Aged medicine.disease Surgery Aortic Aneurysm Blood Vessel Prosthesis medicine.anatomical_structure Treatment Outcome cardiovascular system Female Stents GRAFTS Radiology business Tomography X-Ray Computed Cardiology and Cardiovascular Medicine Vascular Surgical Procedures Aneurysm False |
| Zdroj: | Journal of Vascular Surgery, 49(6), 1387-1394. MOSBY-ELSEVIER |
| ISSN: | 0741-5214 |
| DOI: | 10.1016/j.jvs.2009.02.009 |
| Popis: | Objective: Para-anastomotic aortic aneurysms and progressive aneurysmal degeneration of the aorta after previous open aortic reconstruction pose a challenging clinical scenario. Due to the proximity to the visceral arteries, endovascular exclusion is typically not an option. However, the development of fenestrated and branched endografts has provided a less invasive means of repair. We sought to evaluate our experience using fenestrated endografts in the management of juxtarenal aortic aneurysms after previous open aortic reconstruction.Methods: This is an analysis of patients who have undergone fenestrated endovascular repair specifically for juxtarenal aneurysms in the setting of previous infrarenal open aortic surgery. Patients were treated with customized Cook (William A. Cook Australia, Ltd, Brisbane, Australia) endografts manufactured based on preoperative 3-dimensional (3-D) imaging. All patients underwent repair under the direction of a single surgeon.Results: Eighteen patients were treated from March 2004 to November 2008. All patients had a previous open aortic reconstruction, and 3 patients had two prior reconstructions. The mean time since the last operation was 8.5 years (range, 1-15 years). Mean patient age was 72-years-old (range, 57-80 years). All patients were considered high risk for open surgery due to pre-existing medical co-morbidities and/or the redo nature of their surgery. The mean number of fenestrations per patient was three vessels, including proximal graft scallops. All but one operation (94%) was completed by totally endovascular means. One operation required a planned celiotomy for retrograde access to a left renal artery. Of 56 target vessels, all were successfully revascularized using a combination of: fenestrations with stents (12), or stent grafts (25), as well as graft scallops (18), and directional graft branches with a bridging stent graft (1). Mean operative time was 215 minutes (range, 135-420 minutes) and mean blood loss was 560 cc (range, 100-1500 cc). Thirty-day and 1-year mortality was 0 and 11%, respectively. Perioperative complications occurred in 2 patients. One patient developed a congestive heart failure exacerbation and myocardial infarction, and the other patient a groin wound infection. Mean follow-up time was 23 months and cumulative primary patency was 95% (53/56 vessels), with no follow-tip interventions.Conclusion: Endovascular treatment of juxtarenal aneurysms after prior aortic reconstruction is a viable alternative to open repair with high success and low reintervention rates. These devices will broaden the available treatment modalities for these conditions, and will likely significantly decrease the complication rate of treatment in these high-risk patients. (J Vasc Surg 2009;49:1387-94.) |
| Databáze: | OpenAIRE |
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