13 Twelve Year Results of Fenestrated Endografts for Juxtarenal and Group IV Thoracoabdominal Aneury скачать в хорошем качестве

13 Twelve Year Results of Fenestrated Endografts for Juxtarenal and Group IV Thoracoabdominal Aneury

#FenestratedEndografts #ComplexAneurysm #AorticSurgery #VascularSurgery #LongTermOutcomes #JuxtarenalAneurysm #ThoracoabdominalAneurysm #EndovascularRepair #SurgicalComplications #DeviceEvolution This video deep dive explores the 12-year results of a significant study (Mastracci et al., 2015) on using fenestrated endografts to repair challenging aortic aneurysms near vital arteries (juxtarenal and Group 4 thoracoabdominal aneurysms). Historically, these required major open surgery. Fenestrated grafts offer a less invasive alternative inserted via the groin, featuring custom openings (fenestrations) to preserve blood flow to crucial branches like kidney and gut arteries. The study captured early data from high-risk patients considered unsuitable for open surgery. Key findings revealed a technical success rate of 97%. Crucially, the grafts proved highly effective at preventing aneurysm-related death, with nearly 98% freedom from this outcome at 8 years. This demonstrates the procedure's success in managing the aneurysm itself. However, overall survival at 8 years was lower, around 20%, primarily limited by the patients' other serious health conditions such as age, heart failure, cancer history, and prior repairs. The study highlighted an evolution in the technology and surgical strategy over the 12 years. Initial approaches focused on minimal aortic coverage but led to problematic Type Ia endoleaks (seal failures). The strategy shifted towards covering more aorta and using more fenestrations to achieve a more secure top seal, even if it meant a potentially higher risk of less severe issues like Type III endoleaks or needing more branch interventions. The technology improved with reinforced fenestrations and covered bridging stents, which showed better long-term patency of the branch arteries. While reintervention rates were higher with this complex endovascular approach compared to open surgery, the lower initial surgical risk and excellent aneurysm protection suggest fenestrated endografts will continue to replace open surgery for anatomically suitable patients. The data strongly supports their safety and durability for the aorta itself. Future efforts may focus more on managing patients' comorbidities, which significantly impact long-term survival, rather than solely on device refinement.