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Purpose: Fenestrated endovascular aneurysm repair (FEVAR) is a well-established endovascular treatment option for pararenal abdominal aortic aneurysms in which balloon-expandable covered stents (BECS) are used to bridge the fenestration to the target vessels. This study presents midterm clinical outcomes and patency rates of the Advanta V12 BECS used as a bridging stent. Methods: All patients treated with FEVAR with at least 1 Advanta V12 BECS were included from 2 large-volume vascular centers between January 2012 and December 2015. Primary endpoints were freedom from all-cause reintervention, and freedom from BECS-associated complications and reintervention. BECS-associated complications included significant stenosis, occlusion, type 3 endoleak, or stent fracture. Secondary endpoints included all-cause mortality in-hospital and during follow-up. Results: This retrospective study included 194 FEVAR patients with a mean age of 72.2±8.0 years. A total of 457 visceral arteries were stented with an Advanta V12 BECS. Median (interquartile range) follow-up time was 24.6 (1.6, 49.9) months. The FEVAR procedure was technically successful in 93% of the patients. Five patients (3%) died in-hospital. Patient survival was 77% (95% CI 69% to 84%) at 3 years. Freedom from all-cause reintervention was 70% (95% CI 61% to 78%) at 3 years, and 33% of all-cause reinterventions were BECS associated. Complications were seen in 24 of 457 Advanta V12 BECSs: type 3 endoleak in 8 BECSs, significant stenosis in 4 BECSs, occlusion in 6 BECSs, and stent fractures in 3 BECSs. A combination of complications occurred in 3 BECSs: type 3 endoleak and stenosis, stent fracture and stenosis, and stent fracture and occlusion. The freedom from BECS-associated complications for Advanta V12 BECSs was 98% (95% CI 96% to 99%) at 1 year and 92% (95% CI 88% to 95%) at 3 years. The freedom from BECS-associated reinterventions was 98% (95% CI 95% to 100%) at 1 year and 94% (95% CI 91% to 97%) at 3 years. Conclusion: The Advanta V12 BECS used as bridging stent in FEVAR showed low complication and reintervention rates at 3 years. A substantial number of FEVAR patients required a reintervention, but most were not BECS related.

Purpose: To describe a novel endovascular bailout technique for successful completion of target vessel stenting during branched stent-graft repair of thoracoabdominal aortic aneurysms (TAAA) after ...

PurposeTo review the literature reporting open surgical and endovascular treatment of juxtarenal aortic aneurysm (JAA).MethodsA systematic search of the PubMed database was carried out to identify ...

Purpose: To report the use of a fenestrated cuff for endovascular treatment of a proximal type I endoleak after previous endovascular aneurysm repair (EVAR) that included 2 suprarenal cuffs and 2 Palmaz stents. Case Report: A 71-year-old man had been treated for an infrarenal abdominal aortic aneurysm with a Powerlink stent-graft, 2 additional proximal cuffs with suprarenal fixation, and 2 Palmaz stents extending over the renal arteries. Follow-up demonstrated a type I endoleak and an increase in aneurysm size. A 2-stage endovascular approach featuring a fenestrated cuff was undertaken. Prior to the endoleak repair procedure, both renal arteries were catheterized and the Palmaz stent struts dilated. When the customized fenestrated cuff was available, it was successfully positioned with covered stents in the fenestrations, completely excluding the proximal type I endoleak. Conclusion: Fenestrated stent-grafting is a viable alternative to open repair after failed EVAR, even when previously implanted bare metal stents cross the renal orifices.

Purpose: To evaluate endovascular repair of abdominal aortic aneurysms (AAA) under local anesthesia in the acute setting. Methods: Between 1998 and 2001, 47 patients with an acute AAA were evaluated for endovascular repair after informed consent, provided they were in a stable, albeit hypotensive condition. The patients underwent urgent computed tomography to assess suitability for endovascular repair; 16 were eligible for stent-graft repair: 9 were frank ruptures and 7 were symptomatic aneurysms. Complications and outcome of endovascular repair were evaluated; mortality was compared to a contemporaneous surgical cohort. Results: Seven (23%) of 31 patients having a standard surgical procedure died in the study period compared to 1 (6%) of 16 patients undergoing endovascular repair (following conversion to surgery because of calcified access vessels). Twelve (75%) of the endovascular repairs were performed under local anesthesia; no complications with this mode of anesthesia were encountered. The median duration of the endovascular procedures was 110 minutes (range 75–240); median blood loss was 250 mL (range 100–2800 mL). Only 4 patients required blood transfusion, and only 8 patients required admission to the intensive care unit. There were 3 postoperative complications (1 ischemic colitis, 1 renal failure, 1 groin hematoma). During follow-up, 3 endograft patients received stent-graft extensions in uneventful procedures. Two patients died at 9 and 16 months from cardiac causes. Conclusions: This study demonstrates the feasibility and possible advantages of endovascular repair under local anesthesia in selected acute AAA patients. Further studies are needed to prove the advantages over open repair.

Purpose: To describe the successful endovascular treatment of a popliteal arteriovenous fistula with a stent-graft. Case Report: A 54-year-old man was referred to our hospital with a distal popliteal arteriovenous fistula following an arthroscopic meniscectomy 6 years earlier. Three surgical attempts to close the fistula were undertaken, but the fistula recurred. He now presented with symptoms of progressive venous hypertension with claudication, swelling of the leg, and ulceration at the ankle. The fistula was closed with a stent-graft deployed percutaneously. At 18 months, the patient is doing well; duplex evaluation has documented the patency of the popliteal artery and the stent-graft. Conclusions: Endovascular treatment of a popliteal arteriovenous fistula is an alternative to open surgical reconstruction. In this situation, after multiple failed surgical closures and in a leg with extensive venous hypertension, it may be the best treatment option.