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Zenith Fenestrated AAA Endovascular Graft as a Platform for Physician-modified Fenestrated/branched Endovascualar Aortic Repair of Juxtarenal and Suprarenal Abdominal Aortic Aneurysms
Joshua D. Adams, MD.
Carilion Clinic, Roanoke, VA, USA.

OBJECTIVES: The use of Fenestrated/Branched-endovascular aortic repair (F/B-EVAR) including physician-modified endografts (PMEG) to treat abdominal aortic aneurysms involving the visceral arteries has increased worldwide with excellent results. In the United States, only one customizable fenestrated device is commercially available to treat juxtarenal aneurysms. PMEG with standard thoracic and abdominal aortic endografts have been successfully reported to expand treatment to patients with suprarenal and Thoracoabdominal aortic aneurysm. The purpose of this study was to evaluate the outcomes of using the Zenith Fenestrated AAA Endograft (ZFEN) as a platform for PMEG, including repairs utilizing a combination of commercially produced and physician-modified fenestrations/branches.
METHODS: Review of a prospectively maintained database including all patients who underwent F/B-EVAR from April 2014 through June 2018 was performed. Patients undergoing standard ZFEN repair or PMEG F/B-EVAR for Thoracoabdominal aortic aneurysm, chronic dissection, or patients with significant aortoiliac occlusive disease were excluded. All patients undergoing PMEG F/B-EVAR repair with ZFEN were included in the analysis. Primary endpoints included mortality, length of stay, and secondary reinterventions.
RESULTS: 125 patients were reviewed. Sixty-five patients (48 males/17 females) underwent PMEG F/B-EVAR of juxtarenal or suprarenal AAA with the ZFEN device. Thirty-day mortality was 3% with a median follow up of 16.2 months (range, 0.1-49.8 months) . Median length of stay was 1 days (range, 1-10 days). A total of 243 visceral vessels were targeted (mean, 3.7 0.68) with 99% (242/243) success rate. Cumulative branch patency was 99% (241/242). Ten patients (15%) underwent secondary endovascular interventions.
CONCLUSIONS: F/B-EVAR with the ZFEN platform with the creation of additional PMEG fenestrations/branches is an effective technique to expand the application of the only commercially available fenestrated device in the U.S. to treat juxtarenal and suprarenal AAA which fall outside of the instructions for use. Significant advantages with the ZFEN platform over the use of standard endografts for PMEG are present; however; these techniques should only be performed as part of a comprehensive complex endovascular aortic program.


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