Outcomes of Fenestrated Endografts in the Treatment of Abdominal Aortic Aneurysm in Western Australia (1997–2004)

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Abstract
Purpose: To describe a 7-year experience with abdominal aortic aneurysm (AAA) repair using fenestrated Zenith endovascular endografts. Methods: Six endovascular surgeons from 7 medical centers in Perth, Western Australia, contributed data to this retrospective study of 58 AAA patients (51 men; mean age 75.5±8.5 years, range 60–94) treated with fenestrated endografts. Fenestrations were applied to 116 target vessels; more than half of patients had ≥2 target vessels. The results were based on satisfactory deployment of the stent-graft and fenestrations (technical success), technical success and no complications (procedural success), and aneurysm exclusion with no endoleak, rupture, unresolved complications, or dialysis (treatment success). Results: Technical success was 82.8% for patients (90.5% for target vessels), procedural success was 74.1%, and treatment success was 94.8%. There were no cases of conversion or rupture. The 30-day mortality rate was 3.4% (n=2). Over a mean follow-up of 1.4±1.2 years, 10 (17.2%) patients experienced loss of a target vessel (9.5% of target vessels). Factors associated with target vessel loss were no stent, >60° neck angulation, multiple renal vessels, and vessel diameter ≤4 mm. Four (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: Fenestrated endografts extend the treatment options for infrarenal AAAs with necks unsuitable for standard endovascular repair. This early data show a trend toward higher mortality of selected patients with fenestrated endografts than for standard stent-graft repair, but the mortality rate is comparable to open repair. Target vessel occlusion predominantly results from pre-existing disease or the lack of a stent. The lessons learned from this experience contributed toward guidelines for users of fenestrated endografts.