Fenestrated Endovascular Graft Implantation for Treatment of Juxtarenal Abdominal Aortic Aneurysm: Multicenter Experience in China

ABSTRACT Background Abdominal aortic aneurysms (AAAs) are a common vascular disease, and juxtarenal abdominal aortic aneurysms (JRAAs) pose significant challenges for traditional open surgical repair because of their complex anatomical location. In recent years, endovascular aneurysm repair (EVAR) has emerged as a key treatment option for JRAAs, but data on its application in Chinese patient populations remain limited. This study was conducted to evaluate the safety and efficacy of the Zenith fenestrated endovascular graft in treating JRAAs in Chinese patient population. Methods Clinical data from 30 consecutive patients (86.7% men; mean age, 68 ± 8 years) treated for JRAAs with the Zenith device at 9 institutions in China between 21 February 2011 and 31 August 2014 were retrospectively analyzed. Postoperative follow‐up included clinical examination, abdominal duplex ultrasound, and computed tomography at hospital discharge, 3, 6, and 12 months, and annually thereafter. Results The procedure achieved a 100% technical success rate, with 5 large fenestrations cannulated to the superior mesenteric artery and 52 small fenestrations targeting the renal arteries. Steep angulation made cannulation difficult in five patients. Over a mean follow‐up period of 42 ± 18 months (range, 8–56 months), outcomes included three deaths, none related to aneurysmal rupture or conversion; one dissection at the edge of a left renal covered stent secondary to arterial rupture during implantation; right renal artery migration due to preoperative hematoma compression in one patient; and among 55 targeted renal arteries, two occlusions and five stenoses across four patients (13.3%). Secondary interventions were required in seven patients (23.3%) for Type II ( n = 6) and Type I ( n = 1) endoleaks. Conclusions Endovascular repair of JRAAs using the Zenith device appears to be safe and effective in selected patients treated at experienced centers, with low associated mortality and morbidity. However, long‐term data on device integrity and branch vessel patency are needed.