Increasing Role of Fenestrated and Branched Endoluminal Techniques in the Thoracoabdominal Segment Including Supra- and
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Increasing Role of Fenestrated and Branched Endoluminal Techniques in the Thoracoabdominal Segment Including Supraand Pararenal AAA Eric L. G. Verhoeven1 • Pablo Marques de Marino1 • Athanasios Katsargyris1
Received: 26 November 2019 / Accepted: 9 May 2020 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Abstract Fenestrated and branched stent-grafts are being increasingly used to address complex pararenal and thoracoabdominal aortic aneurysms by endovascular means. The present paper describes the current indications, anatomical suitability and techniques of fenestrated and branched stent-grafts in the treatment for pararenal and thoracoabdominal aortic pathologies. Published outcomes with regard to perioperative mortality and morbidity, survival, reinterventions and target vessel patency during follow-up are also presented. Finally, advantages and disadvantages of endovascular repair as compared to open repair are discussed. Keywords Fenestrated Branched Pararenal aortic aneurysm Thoracoabdominal aortic aneurysm Endovascular procedures Open repair
Over the last two decades, standard endovascular aortic aneurysm repair (EVAR) has become a valid alternative to conventional open surgery for the treatment for anatomically suitable infrarenal abdominal aortic aneurysms (AAA) [1]. The most important anatomic prerequisite for EVAR (long-term) success is the presence of a suitable and durable proximal landing zone. In PAA and TAAA, with no infrarenal landing zone available, customized stentgrafts with fenestrations and/or branches (F/BEVAR) are needed to achieve proximal sealing in the suprarenal or thoracic aorta, with preservation of perfusion to both renal and visceral arteries [2–4]. This article provides an overview of the current status of F/BEVAR for the treatment for complex PAA and TAAA. Special focus is laid on the technique and materials required for F/BEVAR procedures. Perioperative and midterm outcomes are also presented. Fact sheet: Endovascular repair of PAA & TAAA Most important points
Introduction Pararenal aortic aneurysms (PAA) and thoracoabdominal aortic aneurysms (TAAA) are described together as complex aortic aneurysms, because treatment involves the visceral arteries.
& Athanasios Katsargyris [email protected] 1
Department of Vascular and Endovascular Surgery, General Hospital Nuremberg, Paracelsus Medical University Nuremberg, Breslauer Strasse 201, 90471 Nuremberg, Germany
1. FEVAR for PAA and type IV TAAA in high-volume centers is nowadays associated with low mortality and morbidity rates. 2. FEVAR with three or four fenestrations (3x/4x FEVAR) is now increasingly used instead of the standard 2x FEVAR aiming to achieve a longer proximal sealing zone to increase durability. 3. F/BEVAR for more extensive TAAA (Type I-III) may be associated with higher mortality rates. 4. SCI can complicate more extensive TAAA endovascular repair. 5. Fenestrations are preferred for right-an
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