¤CLINICAL INVESTIGATION ¤ Fenestrated and Branched Endografts for the Treatment of Thoracoabdominal Aortic Aneurysms: A Systematic Review Chris N. Bakoyiannis, MD; Konstantinos P. Economopoulos, MD; Sotirios Georgopoulos, MD; Chris Klonaris, MD; Maria Shialarou, MD; Marina Kafeza, MD; and Efstathios Papalambros, MD, PhD First Department of Surgery, Vascular Department, University of Athens, ‘‘Laiko’’ General Hospital, Athens, Greece. ¤ ¤ Purpose: To offer a critical review of the current literature on the use of fenestrated and branched stent-grafts in patients with thoracoabdominal aortic aneurysms (TAAA). Methods: A thorough search of the English-language literature published between January 2000 and September 2009 identified reports of endovascular procedures using fenestrated and/or branched endografts as the intended repair strategy in patients with TAAA. Studies were selected based on specific inclusion criteria: (1) .3 high-risk patients with preoperative diagnosis of TAAA, (2) the intended treatment strategy was an endovascular repair using a fenestrated or branched endograft or both, and (3) patient demographics and outcome data (technical success rate, 30-day mortality, and follow-up length) were clearly stated. From 47 articles initially identified, 7 studies were included in the statistical analysis encompassing 155 patients (mean age 74.4 years, range 41–86) with TAAA averaging 69.2 mm in diameter. The mean follow-up was 11.8 months, and the majority of patients had Crawford type IV aneurysms. Outcome measures of eligible studies were tabulated and then analyzed cumulatively. Results: Technical success was achieved in 94.2% (n5146) of the 155 patients. Twenty- three (18.4%) primary endoleaks were reported. The 30-day mortality was 7.1% (n511), while the 1-year survival rate was 82.6% (n5128). Three (1.9%) patients developed permanent paraplegia and 2 (1.3%) developed permanent paraparesis; renal failure was reported in 9 (5.8%). Overall follow-up mortality was 16.1% (n525). Conclusion: Endovascular treatment with fenestrated or/and branched stent-grafts is a new therapeutic option with encouraging results for patients considered unfit for conventional open repair. However, prolonged follow-up studies are needed in order to draw robust conclusions. J Endovasc Ther. 2010;17:201–209 Key words: thoracoabdominal aortic aneurysm, fenestrated endograft, branched stent- graft, endovascular stent-graft, endovascular repair, systematic review ¤ ¤ Endovascular abdominal aortic aneurysm repair has rapidly expanded since its intro- duction in the late 1980s in Russia. 1 This technique was initially developed in an effort to reduce the significant procedural mortality (5% to 34%) and to eliminate the majority of major complications (e.g., spinal cord ische- mia 2,3 and the renal 4,5 and cardiopulmonary The authors have no commercial, proprietary, or financial interest in any products or companies described in this article. Address for correspondence and reprints: Konstantinos P. Economopoulos, MD, First Department of Surgery, Vascular Department, University of Athens, ‘‘Laiko’’ General Hospital, 17 Agiou Thoma Street, Goudi, Athens 11527, Greece. E-mail: economopoulos@gmail.com J ENDOVASC THER 2010;17:201–209 201 ß 2010 by the INTERNATIONAL SOCIETY OF ENDOVASCULAR SPECIALISTS Available at www.jevt.org