Clinical Impact of Isolated Infrarenal Aortic Stenosis

Abstract

Objectives: To evaluate early outcomes and short-term durability of thoracic stent cuffs in patients with abdominal aortic aneurysms (AAA) and infrarenal necks too large for standard endovascular aneurysm repair (EVAR) who were symptomatic, not suitable for open surgery, and could not wait for a custom fenestrated device to be created. Methods: From July 2010 to December 2012, 13 patients with juxtaor pararenal AAA underwent endovascular repair with thoracic aortic endografts as proximal aortic cuffs in conjunction with standard EVAR devices. The patients were symptomatic and were deemed unfit for open surgery due to severe cardiopulmonary and/or renal comorbidities. All patients had infrarenal neck diameters greater than the indications for use for standard aortic endografts. Primary end points were technical success (as defined by aneurysm exclusion without endoleak), follow-up aneurysm exclusion by computed tomographic angiogram, and 30-day and longterm mortality. Results: Thirteen patients (10 men, 3 women) with a mean age of 77.1 years underwent EVAR who presented with symptomatic juxtaor pararenal abdominal aortic aneurysms. The mean aneurysm size was 7.2 cm, and the mean infrarenal aortic neck diameter was 35.5 mm measured by centerline analysis. Technical success was achieved in 100% of cases. The 30-day mortality was 8% (one of 13 patients). At a mean follow-up of 524 days, there have been no endoleaks or other aneurysm related mortalities. There was one death due to stroke at 605 days postop. Conclusions: Complex endovascular repair of juxta and pararenal AAA using thoracic stents cuffs can be safely and successfully performed in symptomatic patients medically unfit for open repair. Using thoracic stent cuffs below the visceral vessels may reduce the complexity and possibly the risk of repair when compared with fenestrated endografts. These techniques can be used for urgent and emergent cases where the wait time for fenestrated technology is prohibitive. Although our results have demonstrated short-term success, long-term durability of this technique with further evaluation is required.