Fenestrated stent treatment of aneurysms with complex juxtarenal anatomy

Abstract

Background: fenestrated endografts have been developed to enable endovascular proximal anchor by incorporating the visceral segment of the aorta as a sealing zone.
Objective: to show our experience in the endovascular treatment of yuxtarenal aneurysms with fenestrated endograft.
Methods: retrospective observational study was conducted on twelve patients treated with custommade fenestrated endograft. All had unfavorable proximal neck anatomy. 
Results: all procedures were done under local anesthesia from both femoral accesses. Eleven men, average age 73, aneurysm size 62 mm (range 54 - 74 mm). All endografts were implanted successfully.
A total of 38 visceral vessels were incorporated and most commonly included both renal arteries and the superior mesenteric artery. No mortality occurred. In the first tomographic control all branches were patent. One patient developed a type III endoleak after two years at the level of the renal artery, treated by a new covered stent.
Conclusion: this presentation is the most important experience in our country done by a single surgical group. In these patients the endovascular approach was a safe and a less invasive alternative, but still constitutes a technical and technological challenge.