Purpose: To present early results of fenestrated endovascular aneurysm repair (FEVAR) combined with chimney grafts in a high-volume center.
Methods: From July 2011 to July 2016, 45 patients (mean age 73.0±8.8 years; 39 men) with complex aneurysms who were poor candidates for open repair and anatomically ineligible for standard or custom-made FEVAR were treated with chimney FEVAR (chFEVAR). Eight (18%) cases were treated in emergency. In all, 130 target vessels (2.9/patient) were addressed using 21 scallops, 42 open/18 covered chimneys, and 27 custom-made/22 homemade fenestrations.
Results: Successful aneurysm exclusion, successful reconstruction, and technical success rates were 97.8% (44/45), 98.2% (107/109 vessels excluding the scallops), and 93.3% (42/45). Six (13.3%) patients died within 30 days (5 in hospital). Estimated overall survival, freedom from aneurysm-related death, and freedom from aneurysm-related reintervention were 85.9%, 88.5%, and 59.2%, respectively, at 12 months. The target vessel patency rate was 96.0%. At latest follow-up, 1 type Ia and 3 type II endoleaks were present. Sac shrinkage occurred in 18 (54%) patients.
Conclusion: Combined chFEVAR showed good technical feasibility and could be an effective approach in emergent settings and highly selective cases when FEVAR is not feasible. Thirty-day mortality, target vessel patency, and type Ia endoleak rates were acceptable.
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http://dx.doi.org/10.1177/1526602817713472 | DOI Listing |
Diagnostics (Basel)
January 2025
Vascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I-"La Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy.
: This study aimed to evaluate whether gender-related anatomical differences in proximal aortic neck morphology affect the feasibility and outcomes of endovascular aortic aneurysm repair (EVAR) in women with abdominal aortic aneurysms (AAA). : This study performed a retrospective analysis of patients electively treated by EVAR for infrarenal AAA between January 2019 and December 2023. Demographics, anatomical characteristics, and stent graft details were analyzed.
View Article and Find Full Text PDFJ Endovasc Ther
December 2024
Department of Cardiovascular Surgery, Sapporo Medical University, Sapporo, Japan.
Purpose: The Clinical Frailty Scale (CFS), used to define frail patients, is significantly associated with clinical outcomes. The CFS can predict postoperative prognosis after cardiovascular procedures. However, no reports exist on the relationship between frailty defined by the CFS and thoracic endovascular aortic repair (TEVAR) outcomes.
View Article and Find Full Text PDFJ Vasc Surg
November 2024
Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, OH. Electronic address:
J Vasc Surg
November 2024
Division of Vascular & Endovascular Surgery, Department of Surgery, Stanford University, Palo Alto, CA. Electronic address:
Background: Hostile aortic neck anatomy is associated with loss of proximal seal and increased late reinterventions. Although both EndoSuture aneurysm repair (ESAR) and fenestrated endovascular aortic repair (FEVAR) are commercially available options for treatment of short neck aneurysms, branch vessel patency is a potential tradeoff for improved seal with FEVAR owing to the incorporation of renovisceral vessels. This study compares the performance of ESAR vs FEVAR in hostile aortic necks.
View Article and Find Full Text PDFJ Endovasc Ther
October 2024
Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan.
Purpose: To compare the outcomes of endovascular aortic aneurysm repair using a chimney technique (ch-EVAR) with those of the standard EVAR (st-EVAR) for ruptured abdominal aortic aneurysms (RAAA).
Materials And Methods: We implemented ch-EVAR for juxtarenal RAAA based on obvious anatomical indications after converting the strategy for RAAA from open repair to EVAR. A retrospective, cohort-based study was conducted on patients with RAAA who were treated using EVAR in our hospital between July 2011 and March 2022.
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