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Comparison Of Bridging Stent-graft Type In Fenestrated Endovascular Repair Of Abdominal Aortic Aneurysms
Muhammad S. Mazroua, M.B.B.Ch.1, Yash K. Pandya, MD
1, Okechukwu Aloziem
2, Michel S. Makaroun, MD
1, Nathan L. Liang, MD
1.
1Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA,
2University of Pittsburgh, Pittsburgh, PA, USA.
OBJECTIVE: Two types of balloon-expandable stents are commonly used for fenestrated endovascular aneurysm repair (FEVAR). Atrium iCast stents are generally considered to be more rigid while Viabahn VBX stents have more flexibility and a heparin-bonded surface. This study aimed to compare the two as bridging stent-grafts during FEVAR.
METHODS: We conducted a retrospective review of adult patients who underwent FEVAR using commercially available Cook Zenith Fenestrated (ZFEN) grafts at a multi-hospital healthcare institution from 2014 to 2022. Primary outcomes were technical success (stent placement without vessel injury/endoleak), unplanned stent extension, and composite outcome including both. Secondary outcomes included postoperative acute kidney injury (AKI) and long-term outcomes using a composite of stenosis, occlusion, endoleak, and need for re-intervention (Kaplan-Meier method). Analyses were performed per-target-vessel and per-patient.
RESULTS: We identified 139 patients (age 75.4±7.8 years; male 82.0%) with 266 target vessels stented (VBX N=159 [60%]; iCast N=107 [40%]; median diameter 6 mm interquartile range [IQR] [6, 7]), majority renal arteries (N=256 [96.2%]). iCast stents were used exclusively in the first three years of the study period but decreased significantly upon VBX introduction in 2017 to 3.0% in 2022. Technical success was 96.2% (VBX 98.1%; iCast 93.5%, P=.09); unplanned extension was required in 8.3% (VBX 5.7%; iCast 12.1%, P=.07). Composite technical success and freedom from unplanned extension was significantly higher in the VBX group (94.3% [N=150] vs 84.1% [N=90]; P=.01) driven mainly by higher iCast unplanned extension rates. There was no significant difference in 30-day post-operative AKI on per-patient analysis (VBX 12%; iCAST 11%). Median follow-up was 2.8 years (IQR [1.6, 4.8]). iCasts demonstrated better long-term freedom from stent-specific complications at 5-years (96.5% [95% CI: 89.4%-98.9%] vs. 85.1% [75.2%-91.2%], P=.01), driven by higher freedom-from-occlusion rates (100% vs. 92.8% [95% CI: 84.9%-96.7%], P=.01),
Figure-1.
CONCLUSIONS: Both stents performed well overall. VBX bridging stents had better technical performance perioperatively but slightly worse long-term occlusion rates. However, this study is unable to account for operator variability and expanded real-world indications for ZFEN usage over time and further long-term study is necessary.
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