Abstract
Purpose: To evaluate immediate and mid term results of juxtarenal aneurysm repair with an endovascular graft that incorporated the visceral aortic segment with graft material. Materials and Methods: A prospective analysis of patients undergoing implantation of an endovascular device with extension into the renal arteries was conducted. All patients were deemed unacceptable candidates for open surgical repair and had challenging proximal neck anatomy (length ≤ 10 mm, or ≤ 15 mm with a compromising morphology). Fenestrations were customized to accommodate aortic branch anatomy based upon computed tomography (CT) data. Selective visceral ostia were incorporated into the repair using balloon expandable stents following endograft deployment. All patients were evaluated with CT, duplex ultrasound, and abdominal radiograph at discharge, 1, 6, and 12 months and yearly thereafter. Results: A total of 139 patients were treated, with 362 visceral vessels incorporated into the repairs. The most common design involved both renal arteries and the superior mesenteric artery (SMA) (60%). All but one prostheses were implanted successfully without the acute loss of any visceral arteries. The mean follow-up was 21 months (range 0–55 months). Two patients died within 30 days of device implantation. Although pre-discharge images demonstrated 4 type I endoleaks and 3 type III endoleaks, type I endoleak or type III endoleak were not detected in this study population at 30-days follow-up. The aneurysm sac decreased more than 5 mm in 54% of patients at 6 months, in 80% of patients at 12 months, in 79% patients at 24 months. Eighteen patients had elevation of serum creatinine (>30% from baseline), with 5 requiring hemodialysis. Of the 362 vessels incorporated, 11 late renal artery stenoses, 8 renal occlusions, and single SMA stenosis were detected. Conclusion: The placement of endovascular prostheses with graft material incorporating the visceral arteries is technically feasible. The incidence of endoleaks is relatively low. Acceptable intermediate-term outcomes have been achieved in the treatment of juxtarenal aortic aneurysms, although it remains critical to follow the status of stented visceral vessels because of possibility of visceral artery stenoses.
