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Surgeon-Modified Zenith Stent Graft System for Endovascular Repair of Abdominal Aortic Aneurysm with Short Proximal Neck
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iDepartment of Cardiovascular Surgery and Department of Radiology*, Kagawa Prefectural Central Hospital, Takamatsu, Japan, and Present address:Department of Thoracic and Cardiovascular Surgery, Showa University**, Tokyo, Japanj
| Atsushi Aoki** |
Takanori Suezawa |
Mitsuhisa Kotani |
| Shu Yamamoto |
Jun Sakurai* |
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Endovascular repair for abdominal aortic aneurysmiEVARjhas become widespread in Japan because of its low invasiveness. However adequate proximal neck length is required for EVAR. Unfortunately the surgical mortality of para-renal aortic aneurysm cases has been higher than that of infrarenal aortic aneurysm cases, especially in high-risk patients. A manufacture-modified fenestrated Zenith stent graft system has already been developed, however this new device is not yet available in Japan. Furthermore this device could not be used in an emergency situation because it takes 2-3 weeks for preparation. Therefore we introduced a surgeon-modified fenestrated Zenith stent graftifenestrated Zenithjsystem in December 2010 for patients with a proximal neck length of 5-10mm. The fenestrated Zenith was not indicated if the supra-renal angle and proximal neck angle exceeded 35. From May 2007 to February 2012, abdominal aortic aneurysmsiAAAjwith a short neck were repaired with fenestrated Zenith in 11 high-risk patientsigroup Fene), and AAAs with a proximal neck length of more than 15mm were repaired with a standard Zenith in 43 patientsigroup IFU). There were two ruptured AAA in the Fene group. Proximal neck length was significantly shorter in the Fene groupi5.5}1.4mm in the Fene group, 26.4}9.5mm in the IFU group, p0.0001jand proximal neck angle was significantly less in the Fene groupi20}13 in the Fene group, 36}18 in the IFU group, p0.008). The Zenith stentgraft system was deployed successfully in all patients. The frequency of type Ia endoleak detected by angiography after stent graft deployment and balloon attachment did not differ significantlyi36% in the Fene group 26% in the IFU group, p0.475jand the frequency of Palmaz stent requirement for type Ia endoleak which persisted after 10 min of additional balloon attachment also did not differ significantlyi27% in Fene group, 9% in IFU group). All fenestrated renal arteries were shown to be patent by angiography. There was no hospital death despite 2 cases of ruptured AAA, nor were these major complications in either group. Serum creatinine levels at 1, 3, 6 and 30 days after EVAR did not differ significantly between the 2 groups. In 9 out of 11 patients, only type II endoleaks were detected and aneurysm shrinkage tended to be more in Fene groupi9.9}5.7mm in Fene group, 5.4}6.1mm in IFU group, p0.062jon enhanced CT 6 months after EVAR. Also all fenestrated renal arteries were patent in these 9 patients. The surgeon-modified fenestrated Zenith system seemed to be effective for AAA patients with short proximal necks, but long term follow up is mandatory.
Jpn. J. Cardiovasc. Surg. 42:23-29i2013j
KeywordsFpararenal abdominal aortic aneurysm, fenestrated stent graft, Zenith
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