Fenestrated Stent Grafts

A fenestrated stent graft is a fabric tube supported by metal wire stents that reinforces a weak spot in the aorta's wall. The aorta is the body's main artery.

This weak spot in the aorta is often caused by an abnormal bulge called an aneurysm. If an aneurysm ruptures, the result can be fatal.

Through small incisions in the groin, catheters are used to guide and deliver a fenestrated stent graft through the blood vessel and to the aneurysm. The stent graft is then placed in the diseased segment of the aorta. It fits the aorta like a sleeve to divert blood flow away from the aneurysm, minimizing risk of rupture.

The way that fenestrated stent grafts are special is that they can cover branch arteries of the aorta because the stent graft has fenestrations, or holes, that correspond to the position of the branching arteries within the aorta. This allows for blood to flow through the stent graft into the branch vessel. The aneurysm eventually shrinks because blood is being diverted from it.

Why choose Presbyterian for your fenestrated stent grafts?

Presbyterian Heart and Vascular Care has a skilled vascular care team who can provide a wide range of services from diagnosis to treatment. Their surgeons are trained in many different techniques and procedures, many of which can provide you with a shorter recovery period and less hospital time.

Who is eligible for a fenestrated stent grafts?

You may be eligible for a fenestrated stent graft if your aneurysm has not ruptured and is five centimeters or more in size.

Your physician can determine if aortic aneurysm repair is the best treatment by performing imaging studies like these:

• Intravascular ultrasound.
• Magnetic resonance imaging (MRI).
• Angiography (an x-ray of the blood vessels).
• Computed tomography angiogram (CTA) scan.
  
• Transesophageal echocardiography (TEE), to record ultrasound images of your heart from inside your esophagus or food pipe.
  

What conditions can be treated with a fenestrated stent grafts?

Fenestrated stent grafts are usually used on patients with thoracic aortic aneurysms. They are also used to treat pararenal and thoracoabdominal aneurysms.

How do I prepare for a fenestrated stent graft?

Your doctor will evaluate your cardiac, pulmonary, and renal function to see if you are a good candidate for a fenestrated stent graft. The evaluation typically includes a cardiac stress test, pulmonary function tests, and a carotid ultrasound.

Planning for the procedure is based on the structure of your aneurysm. A high-resolution computerized tomography angiography (CTA) with small (one-to-three mm) cuts can be used to evaluate the aneurysm in detail.

What should I expect during my fenestrated stent graft procedure?

A catheter, holding the fenestrated stent graft, is inserted into the femoral artery through a cut in the groin. The stent graft is guided through the blood vessel to the aneurysm.

Once the graft reaches the aneurysm site, the catheter is withdrawn, leaving the stent graft. The stent graft expands to fit against the inner walls of the vessel.

The fenestrations (holes) are positioned over the openings of the branch vessels so that the blood flow continues to the vital organs without putting pressure on the aneurysm.

Your hospital stay is usually 2-3 days. While your recovery will take less time than open-heart surgery would, the early restrictions are similar:

• No driving until approved by your physician (usually within 1-2 weeks).
• No baths until the groin incisions heal; showers and sponge baths around the incision are allowed.
• No lifting more than 10 pounds for approximately 4-6 weeks after the procedure.

How do I care for myself after my fenestrated stent grafts?

You will return for a follow-up visit within one month of the procedure. Follow-up imaging tests will take place 1 and 6 months following the procedure to ensure the stent is working and still in the right place. If your aneurysm is shrinking and no problems are found, your imaging tests will take place yearly.

After you’ve had an endovascular repair of an aneurysm, it is recommended you adopt the same heart-healthy lifestyle led by other heart surgery patients.

Lifestyle changes to reduce further heart problems include:

• Reduce salt in your diet.
• Maintain healthy body weight.
• Never smoke, or stop smoking.
• Drink only moderate amounts of alcohol, if any. This means an average of one to two drinks per day for men and one drink per day for women.
• Eat a healthy, well-balanced diet, rich in fresh fruit and vegetables but low in saturated fats, processed sugar, and salt.
• If you have diabetes, work closely with your doctor to make sure it is controlled.
• Get at least 150 minutes of moderate to intense physical exercise every week.