Fenestrated Endovascular Graft Repairs Aortic Aneurysms

The new graft is similar to the traditional endovascular graft, made of a polyester fabric encased by a stainless steel scaffold. However, it is different from the off-the-shelf graft because of two fenestrations fabricated in the graft to accommodate the renal arteries, which help to keep the graft in place, as well as a scallop-shaped cut to supply blood to the superior mesenteric artery, which carries blood to the intestines.

The graft has three parts - an upper main body, a lower main body, and one leg. An adjunctive alignment stent made of stainless steel is used to help keep the holes in the graft lined up with the arteries that supply the organs. Patients eligible for the new customized graft repair include those whose aneurysms approach within 5 millimeters of the renal arteries, and have large enough vessels to deliver the stent-graft to the appropriate location. The planning process itself includes modeling the patient's aorta using computed tomography (CT), with fabrication of each graft taking about five weeks. The Zenith Fenestrated AAA Endovascular Graft is a product of Cook Medical (Bloomington, IN, USA).

“We do a substantial amount of planning before the endovascular operation to ensure that the graft will be engineered correctly to match the patient's individual anatomy,” said vascular surgeon James Black, MD, of Johns Hopkins Hospital (Baltimore, MD, USA). “At Hopkins, we perform close to 100 open abdominal aortic aneurysm repairs each year for patients who are not eligible for the minimally invasive option. With the new fenestrated stent-graft, we will be able to spare many of those patients a big operation and a long recovery.”

An AAA is a localized dilatation (ballooning) of the abdominal aorta exceeding the normal diameter by more than 50%, and is the most common form of aortic aneurysm. Approximately 90% of AAAs occur infrarenally, but they can also occur pararenally (at the level of the kidneys) or suprarenally. Such aneurysms can extend to include one or both of the iliac arteries in the pelvis. The major complication of AAAs is rupture, which is life-threatening, as large amounts of blood spill into the abdominal cavity, and can lead to death within minutes.]Mortality of rupture repair in the hospital is 60%–90%.

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