Endovascular Treatment of Aortic Aneurysms with Complex Proximal Anatomy

pp. 185-189

Abstract

Background: There are few publications on patients with juxta or pararenal aneurysms, defined as abdominal aortic aneurysms without a proximal neck suitable for standard endovascular anchoring. We present our experience for their endoluminal repair.

Methods: This was an observational and prospective study. The results were evaluated at 30 days and up to 2 years in patients consecutively treated with fenestrated or chimney endografts.

Results: Between July 2015 and July 2017, 21 complex endovascular procedures were performed. Thirteen industrially tailored fenestrated devices and 4 physician-fenestrated devices were implanted. Four patients were treated using the chimney technique. Thirty-three fenestrations (2.5 fenestrations/patient) and 15 chimneys (1.8 stents/patient) were manufactured. Events at 30 days included 4.7% mortality and 9.4% branch occlusions, which were re-permeabilized. Among these patients, 2 presented type I endoleak that was repaired. Mean follow-up time was 15 months. In the 2-year Kaplan-Meier analysis, overall survival was 91.7%; primary blood vessel patency was 85.7% and secondary patency 100%. Type I or type III endoleak-free survival was 91.7% at 1 year, and 81.5% at two years. No mortality associated with the aneurysm or its rupture was recorded during follow-up.

Conclusions: These results show a current, effective and safe option for patients with complex aortic aneurysms, using a minimally invasive tailored approach. Probably, these results have consolidated a more important role of these techniques in the treatment of patients with complex aortic aneurysms.