Fenestrated and branched grafts for para-anastomotic aortic aneurysm repair.

Purpose: To investigate the use of fenestration and branch artery stenting during endovascular stent-graft repair of para-anastomotic aneurysms (PAA).

Methods: A retrospective review was conducted of 9 patients (all men; mean age 71 years, range 60-80) who received custom-designed fenestrated endoprostheses for PAA repair. Eight tubular fenestrated devices and 1 composite device (fenestrated tube plus modular bifurcated body) with a total of 31 fenestrations were used.

Results: The mean operating time was 318+/-93 minutes (range 220-485); the mean fluoroscopy time was 77+/-38 minutes (range 39-158), during which a mean 121+/-81 mL (range 33-300) of contrast was used. Technical success was achieved in all cases. Over a mean follow-up of 12+/-5.5 months (range 6-24), 1 secondary intervention was carried out due to a break in a side branch stent-graft; 2 transient renal impairments and 1 permanent renal insufficiency unrelated to renal artery patency were observed. So far, no vessel loss has emerged.

Conclusion: Conventional repair of PAA has been a standard procedure for many years, though it carries high surgical risk as well as perioperative mortality. Fenestrated endografts may be a promising alternative in selected patients.