Fenestrated anaconda™ endograft for juxta/para-renal aortic aneurysms. Preliminary Italian multi-center experience

BACKGROUND: The AnacondaTM Fenestrated endograft (Vascutek, Inchinnan, UK) is a new device that could be used to treat challenging aortic aneurysms (AAA) involving the abdominal visceral vessels. The aim of the present study was to report the preliminary results of the Italian multi-centers experience. METHODS: Patients undergone fenestrated endovascular aneurysm repair (FEVAR) using AnacondaTM Fenestrated endograft, between May 2012 and November 2014, were prospectively enrolled. Clinical, morphological, intra and postoperative data were collected. Indications for FEVARincluded AAAwith proximal neck unsuitable for standard EVAR. Planning was performed on the computed tomography angiography using dedicated software for the advanced vessels analysis. Primary endpoints were technical success (TS) and 30-day clinical success (CS). Secondary endpoints were: adverse events (type I/III endoleaks, target visceral vessels occlusion)/reinterventions FEVAR-related and AAA-related mortality during the follow-up. RESULTS: Twenty-six patients (male, mean age 74±7years, ASAIII/IV:16/10) underwent FEVARusing AnacondaTM Fenestrated endograft in 11 Italian Vascular Surgery Units for 5 short neck AAAand 21 juxta/para-renal AAA. An overall of 67 target visceral vessels were accommodated by using of fenestrations. Fenestrated endograft with 1, 2, 3 and 4 fenestrations were used in 1, 10, 14 and 1 cases, respectively. Abifurcated and tube endograft was planned in 23 and 3 cases, respectively. In 17/26 (65%) cases the endograft was repositioned during the procedure and in 14/26 (54%) cases almost 1 target visceral vessel was cannulated from the brachial access. TSwas achieved in 24/26 (92%) patients (2 type I endoleak). All the target visceral vessels were successfully cannulated and stented. An occlusion of 1 renal artery and 1 type III endoleak (between the aortic endograft and renal artery stent-graft) occurred within the first week. The 30-day mortality was 7.7% (2/26). The 30-day CS was 80%. The mean follow-up was 12 months (range:1-33). No type I/III endoleaks and target visceral vessels occlusion occurred during the follow-up. There were not re-interventions FEVAR-related and AAA-related mortality. CONCLUSIONS: The AnacondaTM Fenestrated endograft can be used to treat challenging AAAinvolving the abdominal visceral vessels. Larger experiences and long-term data are mandatory to confirm this treatment as safe and effective also in the mid and long term follow-up.