Endoluminal aortic grafting with renal and superior mesenteric artery incorporation by graft fenestration

Purpose: To explore the use of juxta- and suprarenal aortic segments for en dograft fixation in abdominal aortic aneurysm (AAA) patients and to develop methods of graft implantation that use endograft fenestrations to preserve renal and visceral vessel perfusion. Methods: From August 1998 to May 2000, 13 AAA patients with unsuitable infr arenal aortic necks were treated with custom-designed endovascular grafts e mploying the juxta- and suprarenal aortic segments for proximal sealing. Fl ow to 33 renal and superior mesenteric arteries was maintained via graft fe nestrations that were aligned by use of radiopaque graft markers. The fenes tration-orifice interface for renal arteries was secured with modified ball oon-expandable stents. Results: All fenestrated grafts were deployed as planned, and all target ve ssels (33/33) were preserved. Two patients did not receive any stents, one being the first in the series and another who had incorporation of a renal accessory artery only. Without the use of transgraft stenting, 5 renal arte ries would have been occluded by the endograft or poorly perfused. Procedural success was 100%. No conversion to open operation or graft-relat ed complications occurred. There was no primary endoleak in any patient by angiographic criteria. Two patients required additional surgical procedures related to access vessels. Periprocedural mortality at 30 days was nil. Fo llow-up ranging from 3 to 24 months on all patients has not demonstrated an y proximal or distal endoleaks. One stented renal vessel has occluded; all other arteries remain patent at last examination. Conclusions: This study has demonstrated the ability to successfully place a multifenestrated endoluminal graft in an aortic aneurysm using juxta- and suprarenal aortic segments to obtain a satisfactory seal. Stenting of the fenestration-renal ostium junction has helped to maintain renal patency.