The Zenith Aortic Stent-Graft: A 5-Year Single-Center Experience

Abstract

Purpose:

To evaluate the efficacy and midterm results of the Zenith stent-graft in the treatment of abdominal aortic aneurysms (AAA).

Methods:

Since March 1994, 364 patients have undergone endovascular repair of infrarenal AAA. Of the 94 who were treated with the Zenith stent-graft from 1996 to 2002, 88 patients (82 men; mean age 72.6 ± 6.5 years, range 47–88) with at least 6-month follow-up were analyzed. Sixty-one (69.3%) patients were considered at high risk for intervention; 7 ruptured AAAs were treated emergently. In all, 68 (77.3%) bifurcated stent-grafts (including 18 TriFab systems) and 20 aortomonoiliac configurations were used. Cumulative data on endoleak, migration, secondary procedures, and survival were evaluated with Kaplan-Meier analyses.

Results:

Implantation success was 97.7%; 2 (2.3%) access-related failures were converted to open repair (1 immediate, 1 at 3 months). There were 3 (3.4%) graft limb thromboses (2 immediate, 1 late), 3 (3.4%) cases of colon ischemia due to embolization in 1 and hypogastric artery occlusion in 2, and 1 (1.1%) renal infarction due to embolism. Three (3.4%) patients died within 30 days. Eleven (12.5%) endoleaks and 1 (1.1%) late endograft migration were recorded. The 5-year cumulative endoleak and migration rates were 15% and 7%, respectively. Sixty-three (71.6%) patients did not present any complication related to the repair during a mean follow-up of 20.6 ± 14.9 months (range 6–68); notably, no complications were associated with the 18 TriFab systems. Six (6.8%) secondary procedures were performed (31% 5-year cumulative secondary procedural rate). All 6 (6.8%) aneurysm-related deaths (the 3 perioperative, 2 from late AAA rupture, and 1 during a secondary procedure) and 14 of 18 (20.4%) non-aneurysm—related deaths occurred in high-risk patients; the 5-year cumulative survival rates were 57% for any death and 92% for aneurysm-related deaths.

Conclusions:

The Zenith stent-graft appears both safe and effective in terms of midterm outcome of endovascular aortic aneurysm repair.

Keywords

abdominal aortic aneurysm proximal aortic neck high-risk patient Zenith

Get full access to this article

View all access options for this article.

References

Chuter

Risberg

Hopkinson

. Clinical experience with a bifurcated endovascular graft for abdominal aortic aneurysm repair. J Vasc Surg. 1996;24:655–666.

May

White

Waugh

. Comparison of first- and second-generation prostheses for endoluminal repair of abdominal aortic aneurysms: a 6-year study with life table analysis. J Vasc Surg. 2000;32:124–129.

Laheij

Buth

Harris

. Need for secondary interventions after endovascular repair of abdominal aortic aneurysms. Intermediate-term follow-up results of a European collaborative registry (EUROSTAR). Br J Surg. 2000;87:1666–1673.

Chuter

Reilly

Faruqi

. Endovascular aneurysm repair in high-risk patients. J Vasc Surg. 2000;31:122–133.

Harris

Vallabhaneni

Desgranges

. Incidence and risk factors of late rupture, conversion, and death after endovascular repair of infrarenal aortic aneurysms: the EUROSTAR experience. J Vasc Surg. 2000;32:739–749.

Lawrence-Brown

Hartley

MacSweeney

. The Perth endoluminal bifurcated graft system—development and early experience. Cardiovasc Surg. 1996;4:706–712.

Lawrence-Brown

Sieunarine

Hartley

. The Perth HLB bifurcated endoluminal graft: a review of the experience and intermediate results. Cardiovasc Surg. 1998;6:220–225.

Greenberg

Lawrence-Brown

Bhandari

. An update of the Zenith endovascular graft for abdominal aortic aneurysms: initial implantation and mid-term follow-up data. J Vasc Surg. 2001;33:S157–164.

Stanley

Semmens

Mai

. Evaluation of patient selection guidelines for endoluminal AAA repair with the Zenith stent-graft: the Australasian experience. J Endovasc Ther. 2001;8:457–464.

10.

White

May

Waugh

. Type I and type II endoleaks: a more useful classification for reporting results of endoluminal AAA repair. J Endovasc Surg. 1998;5:189–191.

11.

White

May

Waugh

. Type III and type IV endoleak: toward a complete definition of blood flow in the sac after endoluminal AAA repair. J Endovasc Surg. 1998;5:305–309.

12.

Harris

. Management of endoleak and endotension. In: Greenhalgh

, ed. Vascular and Endovascular Surgical Techniques. 4th ed. London, England: WB Saunders; 2001:265–269.

13.

Resch

Malina

Lindblad

. The impact of stent-graft development on outcome of AAA repair—a 7-year experience. Eur J Vasc Endovasc Surg. 2001;22:57–61.

14.

Lobato

Quick

Vaughn

. Transrenal fixation of aortic endografts: intermediate follow-up of a single-center experience. J Endovasc Ther. 2000;7:273–278.

15.

Kichikawa

Uchida

Maeda

. Aortic stent-grafting with transrenal fixation: use of newly designed spiral Z-stent endograft. J Endovasc Ther. 2000;7:184–191.

16.

Bove

Long

Zelenock

. Transrenal fixation of aortic stent-grafts for the treatment of infrarenal aortic aneurysmal disease. J Vasc Surg. 2000;32:697–703.

17.

Chuter

Wendt

Hopkinson

. European experience with a system for bifurcated stent-graft insertion. J Endovasc Surg. 1997;4:13–22.

18.

Criado

Wilson

Fairman

. Update on the Talent aortic stent-graft: a preliminary report from United States phase I and II trials. J Vasc Surg. 2001;33:S146–149.

19.

White

. Clinical and design update on the development and testing of a one-piece, bifurcated, polytetrafluoroethylene endovascular graft for abdominal aortic aneurysm exclusion: the Endologix device. J Vasc Surg. 2001;33:S154–156.

20.

Resch

Malina

Lindblad

. The impact of stent design on proximal stent-graft fixation in the abdominal aorta: an experimental study. Eur J Vasc Endovasc Surg. 2000;20:190–195.

21.

Marin

Parsons

Hollier

. Impact of transrenal aortic endograft placement on endovascular graft repair of abdominal aortic aneurysms. J Vasc Surg. 1998;28:638–646.

22.

Liapis

Kakisis

Kaperonis

. Changes of the infrarenal aortic segment after conventional abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg. 2000;19:643–647.

23.

Resch

Ivancev

Brunkwall

. Midterm changes in aortic aneurysm morphology after endovascular repair. J Endovasc Ther. 2000;7:279–285.

24.

White

Donayre

Walot

. Computed tomography assessment of abdominal aortic aneurysm morphology after endograft exclusion. J Vasc Surg. 2001;33:S1–10.

25.

Makaroun

Deaton

. Is proximal aortic neck dilatation after endovascular aneurysm exclusion a cause for concern? J Vasc Surg. 2001;33:S39–45.

26.

Prinssen

Wever

Mali

. Concerns for the durability of the proximal abdominal aortic aneurysm endograft fixation from a 2-year and 3-year longitudinal computed tomography angiography study. J Vasc Surg. 2001;33:S64–69.

27.

Sonesson

Malina

Ivancev

. Dilatation of the infrarenal aneurysm neck after endovascular exclusion of abdominal aortic aneurysm. J Endovasc Surg. 1998;5:195–200.

28.

Howell

Strickman

Mortazavi

. Preliminary results of endovascular abdominal aortic aneurysm exclusion with the AneuRx stent-graft. J Am Coll Cardiol. 2001;38:1040–1046.

29.

Bush

Lumsden

Dodson

. Midterm results after endovascular repair of the abdominal aortic aneurysm. J Vasc Surg. 2001;33:S70–76.

30.

Liewald

Scharrer-Pamler

Gorich

. Intraoperative, perioperative and late complications with endovascular therapy of aortic aneurysm. Eur J Vasc Endovasc Surg. 2001;22:251–256.

31.

Hölzenbein

Kretschmer

Thurnher

. Midterm durability of abdominal aortic aneurysm endograft repair: a word of caution. J Vasc Surg. 2001;33:S46–54.

32.

Chuter

Faruqi

Sawhney

. Endoleak after endovascular repair of abdominal aortic aneurysm. J Vasc Surg. 2001;34:98–105.

33.

Petrik

Moore

. Endoleaks following endovascular repair of abdominal aortic aneurysm: the predictive value of preoperative anatomic factors—a review of 100 cases. J Vasc Surg. 2001;33:739–744.

34.

Buth

Laheij

. Early complications and endoleaks after endovascular abdominal aortic aneurysm repair: report of a multicenter study. J Vasc Surg. 2000;31:134–146.

35.

Hinchliffe

Singh-Ranger

Davidson

. Rupture of an abdominal aortic aneurysm secondary to type II endoleak. Eur J Vasc Endovasc Surg. 2001;22:563–565.

36.

Meier

Parker

Godziachvili

. Endotension after endovascular aneurysm repair: the Ancure experience. J Vasc Surg. 2001;34:421–427.

37.

Carpenter

Neschis

Fairman

. Failure of endovascular abdominal aortic aneurysm graft limbs. J Vasc Surg. 2001;33:296–303.

38.

Amesur

Zajko

Orons

. Endovascular treatment of iliac limb stenoses or occlusions in 31 patients treated with the Ancure endograft. J Vasc Interv Radiol. 2000;11:421–428.

39.

Baum

Shetty

Carpenter

. Limb kinking in supported and unsupported abdominal aortic stent-grafts. J Vasc Interv Radiol. 2000;11:1165–1171.

40.

Karch

Hodgson

Mattos

. Adverse consequences of internal iliac artery occlusion during endovascular repair of abdominal aortic aneurysms. J Vasc Surg. 2000;32:676–683.

41.

Yano

Morrissey

Eisen

. Intentional internal iliac artery occlusion to facilitate endovascular repair of aortoiliac aneurysms. J Vasc Surg. 2001;34:204–211.

42.

Jones

Cahill

Gardham

. Outcome in patients with a large abdominal aortic aneurysm considered unfit for surgery. Br J Surg. 1998;85:1382–1384.