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Technical Assessment of the Preloaded Fenestrated Stent-Graft in the Management of Pararenal Aortic Aneurysms

Purpose To assess the effectiveness of the 20-F preloaded fenestrated stent-graft (FSG) to facilitate safe and quick catheterization of both renal arteries and its impact on relevant procedure variables in the management of pararenal aortic aneurysms (PAAs). Methods Between June 2012 when preloaded FSG became available in our institution and February 2013, 10 patients (9 men; mean age 70±10 years) with PAAs were treated by the same surgeon with preloaded FSGs consisting of 3 fenestrations with/without a scallop for the celiac trunk. In the same time frame, 12 patients (11 men; mean age 72±8 years) received standard FSGs with the same fenestration configuration by the same surgeon and were considered as controls. The decision to use the standard vs. preloaded FSG was random; no selection criteria were applied. Main outcome measures were the time interval between insertion of the main graft and advancement of sheaths in all target vessels, total operating time, the amount of iodine, the radiation dose area product, and the fluoroscopy time. Results The median time to sheath introduction into the fenestrations in the preloaded FSG group was significantly shorter (19 minutes, range 15–36) vs. the 48 minutes (range 30–65) of the control group (p=0.001). The mean operating time was 178±28 minutes in test group and 251±50 minutes in the controls (p=0.006). The median fluoroscopy time was shorter in the preloaded FSG group (61 minutes, range 41–73) vs. 83 minutes (range 51–290) in the controls (p=0.002). The radiation dose was significantly lower [3 mGym2 (range 1.4–6.1) vs. 4.9 mGym2 (range 3.6–12.7), p=0.004], as was the amount of iodine (37.4±9.5 g vs. 50±11.7 g, p=0.01). Conclusion The technique of fenestrated stent-grafting for PAAs using a preloaded device is feasible. Compared to standard FSGs, the preloaded design seems to be beneficial in terms of reducing the times for catheterization of all target vessels (60% shorter), fluoroscopy (27% shorter), and the procedure (29% shorter). The radiation dose and the amount of iodine used were less as well (39% and 25%, respectively).