Lessons learned over 2 decades of fenestrated-branched endovascular aortic repair.

Fenestrated-branched endovascular repair has been disseminated worldwide from a technique used to treat high-risk patients to a valid alternative in almost any patient who is anatomically suitable and has complex abdominal and thoracoabdominal aortic aneurysms. As with any new procedure, there is a steep learning curve that goes beyond proficiency with deployment. Ultimately, patient selection, team performance, surgeon's ability to adapt to unexpected events, and the constant evolution of improvements in technical aspects all affect the early outcomes and durability of the repair.

Postoperative management in patients with complex aortic aneurysms.

Patients with complex aortic aneurysms (CAA) are often high risk due to advanced age and widespread atherosclerosis affecting numerous vascular territories. Therefore, a thorough perioperative evaluation is needed prior to performing in any type of aortic repair, regardless of whether an endovascular or open surgical approach is selected. Because these operations are technically demanding and often result in end organ ischemia, it is not surprising that complex aortic repair carries significant risk of morbidity and mortality.

Bilateral external iliac artery pseudoaneurysms causing urinary obstruction and acute renal failure.

Background: We report an exceedingly rare case of bilateral external iliac artery pseudoaneurysms causing urinary obstruction and acute renal failure.

Case Presentation: A young man presented with acute severe bilateral testicular pain radiating to the back. Clinical and radiological workup showed bilateral external iliac artery pseudoaneurysms, which caused bilateral ureterohydronephrosis due to urinary obstruction with subsequent renal failure.

Endovascular repair for thoracoabdominal aortic aneurysms: current status and future challenges.

Open surgical repair has been the gold standard for treatment of thoracoabdominal aortic aneurysms (TAAA). Currently, open surgical repair has been reserved mostly for young and fit patients with connective tissue disorders, using separate branch vessel reconstructions instead of 'island' patches, and distal perfusion instead of a 'clamp and go' technique. Endovascular repair has gained widespread acceptance because of its potential to significantly decrease morbidity and mortality.

Midterm Outcomes of a Prospective, Nonrandomized Study to Evaluate Endovascular Repair of Complex Aortic Aneurysms Using Fenestrated-Branched Endografts.

Objective: The aim of this study was to investigate the midterm outcomes of fenestrated and branched endovascular aortic repair (FB-EVAR) of pararenal (PRA) and thoracoabdominal aortic aneurysms (TAAAs).

Summary Background Data: FB-EVAR has been associated with decreased morbidity compared to open repair, but there is limited midterm data.

Methods: A total of 430 patients (302 males, mean age 74 ± 8 years) treated by FB-EVAR were enrolled in a prospective, nonrandomized investigational device exemption study.

Endovascular treatment of ruptured abdominal aortic aneurysm with aortocaval fistula based on aortic and inferior vena cava stent-graft placement.

A ruptured abdominal aortic aneurysm (RAAA), complicated by an aortocaval fistula (ACF), is usually associated with high morbidity and mortality during open operative repair. We report a case of endovascular treatment of an RAAA with ACF. After accessing both common femoral arteries, a bifurcated aortic stent graft was placed.