Purpose: To demonstrate that in situ fenestration (ISF) of an aorto-uni-iliac endograft to treat aortoiliac disease with narrow distal aorta (NDA) vessels is effective and safe.
Materials and methods: Data for all patients treated by use of ISF between August 2014 and December 2019 were retrospectively analyzed. The series included 27 patients, aged 70 years ± standard error (SE) 11. The pathologies treated included aortoiliac occlusive disease (n = 16), asymptomatic abdominal aortic aneurysm (n = 8), and a ruptured abdominal aortic aneurysm (n = 3). The technique consisted of deploying an aorto-uni-iliac graft, which was converted into a bifurcated repair through contralateral iliac ISF. The inclusion criteria encompassed the presence of an abdominal aortic aneurysm (diameter of >50 mm, rapid growth, ruptured or symptomatic) associated with NDA or the presence of severe aortoiliac occlusive disease with NDA. NDA is defined as an aortic diameter of <16 mm.
Results: The mean aortic bifurcation diameter was 11.9 mm ± SE 1.5. In total, 55% of the fenestrated endografts were performed with a multifilament polyester endograft and 45% with expanded polytetrafluoroethylene endograft. Technical success was 100%. Fluoroscopy time was 28 minutes ± SE 12, and 94 mL ± SE 43 of iodinated contrast medium was used. In the postoperative course, a single minor retroperitoneal hematoma was identified. The mean hospital stay was 5 days ± SE 3. At the mean follow-up of 26 months ± SE 22, overall primary patency was 94% and no endoleak was observed at the ISF site.
Conclusions: The ISF technique is safe and effective in the treatment of aortoiliac disease with NDA. Comparisons with alternative techniques are needed to determine the long-term durability.
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