Superior mesenteric artery outcomes after fenestrated endovascular aortic aneurysm repair

Salim Lala, Martyn Knowles, David Timaran, Mirza Shadman Baig, James Valentine, Carlos Timaran

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

Abstract

Objective The Zenith (Cook Medical, Bloomington, Ind) fenestrated endovascular graft may be designed with single-wide scallops or large fenestrations to address the superior mesenteric artery (SMA). Misalignment of the SMA with an unstented scallop or a large fenestration is possible. This study assessed SMA outcomes after fenestrated endovascular aortic aneurysm repair (FEVAR). Methods During an 18-month period, 47 FEVARs were performed at a single institution. For analysis, patients were grouped according to unstented (n = 23) vs stented (n = 24) SMA scallops/fenestrations. The Institutional Review Board approved this single-institution observational study. Because this was a retrospective review of the data, patient consent was unnecessary for the study. Results Technical success for FEVAR was 100%. The median follow-up period was 7.7 months (range, 1-16 months). Nine of 21 patients (43%) in the unstented group had some degree of misalignment of the SMA (range, 9%-71%). Among these, four patients (44%) developed complications: three SMA stenoses and one occlusion. The mean peak systolic velocity in patients with and without SMA misalignment was 317.8 cm/s vs 188.4 cm/s (P <.08), respectively. No misalignment occurred in the stented group, and only one of 19 patients (5%) developed an SMA stenosis that required angioplasty. Overall, patients with unstented SMAs had significantly more adverse events directly attributable to SMA misalignment than the stented group (44% vs 5%, respectively; P <.05). Conclusions Misalignment of the SMA with the use of unstented unreinforced scallops or fenestrations occurs frequently. Routine stenting of single-wide and large fenestrations, when feasible, may be a safer option for patients undergoing FEVAR.

Original languageEnglish (US)
Pages (from-to)692-697
Number of pages6
JournalJournal of vascular surgery
Volume64
Issue number3
DOIs
StatePublished - Sep 1 2016
Externally publishedYes

Bibliographical note

Funding Information:
Author conflict of interest: C.H.T. receives consulting and research grant support from Cook Medical Inc. Cook Medical did not have any involvement in the study design, collection, analysis, and interpretation of data, manuscript writing, or the decision to submit the manuscript for publication.

Publisher Copyright:
© 2016 Society for Vascular Surgery

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