Outcomes and Lessons Learned from Fenestrated Grafting in Western Australia: Review of 58 Cases

Abstract

Purpose: To describe the outcomes of 58 patients with an aneurysm of the abdominal aorta who were treated with a fenestrated Zenith stent-graft in Perth (Western Australia) between October 1797 and September 2004. Methods: Six endovascular surgeons contributed data to this longitudinal, retrospective, multicenter study involving 58 patients (mean age 75.5±8.5 years) treated with fenestrated stent-grafts. The data for all cases were collected from the medical records, company supply records, and planning charts. Patient deaths were ascertained from the medical records and the State Death Registry. The results of the endovascular aneurysm repair was determined on the basis of procedural, technical, and treatment success.Results: Fenestrated stent-grafts were used in 116 target vessels: 56.8% of patients had 2 or more target vessels. Technical success was 82.8% for patients (and 90.5% for target vessels treated); procedural success was 74.1%, and treatment success was 86.2%. There were no cases of conversion or rupture. The 30-day mortality rate was 3.4% (2 patients). Loss of target vessels occurred in 19.0% of patients (9.5% of target vessels). Factors associated with loss of target vessel were unstented vessel, >60° angulation of the aneurysm neck, multiple renal vessels, and vessels less than/equal to 4 mm in diameter. Over a 1.4± 1.2-year follow-up, 4 (6.9%) patients developed renal impairment, but none required dialysis. Fourteen (24.1%) patients had a secondary intervention. Unresolved endoleaks persisted in 1 (1.7%) patient. Conclusion: The use of the fenestrated stentgraft extends the options for patients with infrarenal aortic aneurysm that have necks unsuitable for standard endovascular repair. It carries higher risks of mortality than for standard endovascular repair. The mortality of selected patients with fenestrated stent-grafts is comparable to the mortality for open repair. Target vessel occlusion predominantly results from pre-existing disease or the lack of a stent. The lessons learned contribute toward the guidelines for users of fenestrated stent-grafts.