FENESTRATED AND BRANCHED ENDOVASCULAR REPAIR OF THORACOABDOMINAL AORTIC ANEURYSMS

Thomas L. Forbes MD¹, Stewart W. Kribs MD¹ & Cherrie Z. Abraham MD^2
1 London HSC & The University of Western Ontario, London, ON, Canada
² Sir Mortimer B Davis Jewish General Hospital & McGill University, Montreal, QC, Canada

Objective:  To describe our initial experience with endovascular repair of thoracoabdominal aortic aneurysms (TAAA) with fenestrated and branched stent grafts.

Methods:  Two elderly males presented with 70 and 74 mm diameter TAAA’s, each having had open infrarenal abdominal aortic aneurysm repair previously.  One patient had a concomitant left renal artery bypass.  Both patients were deemed high risk for open repair because of medical comorbidities.  Custom fenestrated and branched endografts were designed with the Cook (Australia) Endovascular Planning Group.  One patient’s endograft included 3 fenestrations (celiac axis, superior mesenteric artery, right renal artery) while the other employed a branch (celiac axis) and fenestration (superior mesenteric artery).  Both cases were performed in the operating room under general anesthesia with cerebrospinal fluid drainage and portable C-arm fluoroscopy.

Results:  Both cases were technically successful.  The branch and fenestrations were fixed to their respective arterial orifice with Fluency or Atrium covered stents.  Completion angiography demonstrated no endoleaks and perfusion of all 5 target visceral arteries.  One patient required planned retroperitoneal conduit placement because of inadequate access vessel caliber, while the other required unilateral popliteal artery thrombectomy at the end of the procedure.  This patient suffered from early unilateral lower extremity paresis that completely resolved.  Recovery was otherwise uneventful for both patients.  CT scans at 3 and 4 months respectively demonstrated no endoleaks and perfusion in all 5 target visceral arteries.  
   
Conclusion:  In our initial experience, branched and fenestrated endovascular repair of TAAA’s has proven to be an attractive option for elderly and medically compromised patients, with encouraging short term results.