Treatment of Complex Aortic Aneurysms with Fenestrated Endografts - First Results

Background: The continuous development of endografts allows the treatment of complex aneurysms including the renovisceral and thoracoabdominal aortic segment with fenestrated and branched systems. Long-term follow-up studies of the endovascular method do not exist so far. The intention of this retrospective study is to analyse the long-term benefit of this technique. Method/patients: We included 61 patients in this study, who were treated with fenestrated or branched endografts from August 2001 until December 2007 because of abdominal or thoracoabdominal aneurysms. The 56 males and 5 females - 73 +/- 8 years old - were mostly classified as high-risk patients (72% ASA III, 13% ASAVI). All patients underwent clinical follow-up examination and a CT scan. In 60 cases (98%) the endograft was implanted by a percutaneous technique. 85% of the operations could be done under local or regional anaesthesia. In total we integrated 139 renal and visceral vessels in the grafts. Results: The 30-day mortality rate was 0%. During the postoperative days until discharge we documented general - especially cardiac and pulmonary - complications in 16% of the cases. After a mean follow-up time of 27 months (8-84 months) the late mortality rate was 21.3% (n=13). The aneurysm-related mortality rate was 4.9% (n=3). The endoleak rate was 6.6% (n=4). During the follow-up time 7 patients permanently became dialysis dependent (11%). The main reasons were acute progressions of chronic renal insufficiency after contrast administration (n=2) and device fractures of bare metal stents. Conclusion: The results of this study show the feasibility of endovascular treatment of complex aortic aneurysms even in multimorbid patients with minor postoperative mortality and morbidity. One essential factor for success is a strict patient selection on the basis of anatomic criteria and the use of durable stent material (covered stent grafts as a bridging device).