Single Centre Results of Total Endovascular Repair of Complex Aortic Aneurysms with Custom Made Anaconda Fenestrated Stent Grafts

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Fenestrated endovascular aneurysm repair (F-EVAR) has increased the number of patients with aneurysmal disease and a short or no existing neck being eligible for endovascular treatment. The aim of the study is to report experience using the Anaconda fenestrated device with special emphasis on target vessel patency and pitfalls with the device. Between 2011 and 2016, 48 F-EVAR procedures were performed in 37 males and 11 females under general anaesthesia using the Anaconda custom made device (CMD). Cerebrospinal fluid drainage was performed in selected cases only. Primary endpoints were 30 day mortality and any stent graft related complications. The median aneurysm diameter was 56mm. Most of the patients had a juxtarenal aneurysm and six had an aorto-iliac aneurysm. The primary technical success was 94% with three unsuccessful cannulations of reno-visceral arteries, two of which were successfully performed later. In the third patient an open repair was necessary because of occlusion of the main graft. The 30 day mortality was 4% because of colonic ischemia with two thrombotic occlusions of the superior mesenteric artery. Thirty day morbidity included four cases (8%) of acute limb ischemia: one with a complete limb occlusion caused by a torsion of the main body; two cases (4%) of assumed temporary spinal cord ischemia; six cases (12%) of acute renal failure; and 16 endoleaks (33%) (15 type II, 1 type III). During the median 24 months (range 0-53) follow up, three patients died (6%). One had migration of the stent graft, leading to open repair and post-operative multi-organ failure. The second had graft limb occlusion and died because of multi-organ failure caused by post-operative thrombosis of the reno-visceral stents. The third patient died of an unrelated cause. Two occlusions of the right renal stent/artery were detected. Moreover, there were three cases (6%) of late partial and seven cases (15%) of total graft limb thrombosis, with one being bilateral. "Real world" feasibility of the fenestrated Anaconda stent graft is demonstrated with 4% peri-operative mortality. Target vessel patency is in line with other series; however, limb thrombosis during follow up is of concern.