An Analysis of the French Multicentre Experience of Fenestrated Aortic Endografts: Medium-Term Outcomes

Purpose: To evaluate the medium-term outcomes following aortic aneurysm repair utilizing fenestrated endografts performed in 13 French academic centers. Materials and Methods: A retrospective analysis of prospectively collected data. All patients had asymptomatic aneurysms involving or close to the visceral-bearing abdominal aorta and were judged to be at high-risk for open surgical repair. Fenestrated endografts were designed using computed tomography reconstructions performed on three-dimensional workstations. The procedures were conducted under fluoroscopic control by experienced endovascular teams. All patients were evaluated with computed tomography, duplex ultrasound, and plain film radiograph at discharge, 6, 12, 18, and 24 months, and annually thereafter. Results: Eighty patients (78 males) were treated over 44 months (May 2004–January 2008). Median age and aneurysm size were 78 years (range: 48–90 years) and 59 mm (range: 47–82 mm), respectively. A total of 237 visceral vessels were perfused through a fabric fenestration (median of 3 per patient). One early conversion to open surgery was required. Completion angiography showed that 234 of 237 (99%) target vessels were patent. Two patients (2.5%) died within 30 days of device implantation. Predischarge imaging identified 9 (11%) endoleaks: 3 type I, 5 type II, and 1 type III. The median duration of follow-up was 10 months (range: 1–38 months). No aneurysms ruptured or required open conversion during the follow-up period. Four of 78 (5%) died during follow-up (actuarial survival at 24 months 92%), none of these deaths were aneurysm related. Aneurysm sac size decreased by more than 5 mm in 33%, 53%, and 58% at 6, 12, and 18 months, respectively. One patient had sac enlargement within the first year, associated with a persistent type II endoleak. In-stent stenoses or occlusion affected 4 renal arteries. Secondary procedures were performed in 8 patients (10%) during follow-up, 5 to correct endoleaks and 3 to correct threatened visceral vessels. Conclusions: The use of endovascular prostheses with graft material incorporating the visceral arteries is safe in high risk patients with high risk aneurysms. In the medium-term it is effective in preventing rupture. However, meticulous follow-up to assess sac behavior and visceral ostia is critical to ensure optimal results.