BACKGROUND
Complex and thoracoabdominal aortic aneurysms are one of the most difficult clinical problems of vascular surgery due to high perioperative mortality in open surgeries and limited possibilities of standard endovascular aortic repair. The development of fenestrated and branched endografts has allowed to significantly expand the indications for endovascular treatment by preserving the visceral brunch perfusion under anatomically adverse conditions.
OBJECTIVE
To evaluate the efficacy and safety of endovascular repair of complex and thoracoabdominal aortic aneurysms using fenestrated and branched endografts.
MATERIAL AND METHODS
A retrospective single-center cohort study included 95 patients who underwent endovascular repair of the abdominal or thoracoabdominal aortic aneurysms using fenestrated and/or branched endografts between January 2022 and June 2025. Individually manufactured devices (custom-made), universal factory branched components and «on the table» endograft modification were used; the number of fenestrations varied from 1 to 4. Technical success (patency of all target vessels, absence of type I/III endoleaks, no conversion) was the main intraoperative endpoint. Clinical success (absence of contrast-induced nephropathy, mesenteric and spinal ischemia, myocardial infarction and stroke) was evaluated in the hospital period. Survival (aortic-related and overall), secondary interventions and endoleaks were analyzed in the long-term period. Control multispiral computed tomography was performed after 30 days and 12 months.
RESULTS
Technical success was achieved in 92 (96.8%) patients. Conversion to open surgery was required in one (1.1%) case. Mean duration of intervention was 165 [120; 205] minutes, volume of contrast media — 240 [160; 300] ml. Clinical success amounted to 95.8%; complications included contrast-induced nephropathy in 3 (3.2%) patients and myocardial infarction in one (1.1%). In-hospital deaths were not recorded. In the long-term period, type IA and type IB endoleaks were revealed in 2 (2.1%) patients, type II endoleaks — in 6 (6.3%); 3 (3.2%) secondary interventions were performed. One long-term fatal outcome (1.1%) not related to aortic pathology was recorded.
CONCLUSION
Endovascular repair of complex and thoracoabdominal aortic aneurysms using fenestrated and branched endografts has demonstrated a high frequency of technical and clinical success with low levels of in-hospital and long-term mortality. Precise preoperative planning, individualization of device selection and use of combined techniques ensure the safety and efficacy of the indicated tactics in patients with adverse anatomy and high comorbidity.
