TY - JOUR
T1 - Abdominal aortic aneurysm repair with the Zenith stent graft
T2 - Short to midterm results
AU - Abraham, Cherrie Z.
AU - Chuter, Timothy A.M.
AU - Reilly, Linda M.
AU - Okuhn, Stephen P.
AU - Pethan, Lisa K.
AU - Kerlan, Robert B.
AU - Sawhney, Rajiv
AU - Buck, David G.
AU - Gordon, Roy L.
AU - Messina, Louis M.
N1 - Funding Information:
From the Divisions of Vascular Surgery and Interventional Radiology, University of California–San Francisco. Sponsored in part by grants from the Pacific Research Foundation. Competition of interest: Dr Chuter receives income from patent licensing agreements with William Cook, Inc and Guidant Corp. In addition, Dr Chuter served as a paid consultant for Guidant Corp, William Cook, Inc, and WL Gore, Inc. Presented at the Sixteenth Annual Meeting of the Western Vascular Society, Santa Fe, NM, Sep 23-26, 2001. Reprint requests: Dr Tim Chuter, UCSF Vascular Surgery, 505 Parnassus Ave, M-488, Box 0222, San Francisco, CA ( e-mail: chutert@surgery.ucsf.edu). Submitted Oct 4, 2001; accepted Dec 14, 2001. Copyright © 2002 by The Society for Vascular Surgery and The American Association for Vascular Surgery. 0741-5214/2002/$35.00 + 0 24/6/125032 doi:10.1067/mva.2002.125032
PY - 2002/8
Y1 - 2002/8
N2 - Purpose: The purpose of this study was to assess the short-term and mid-term results of endovascular aneurysm repair with the Zenith stent graft (J Vasc Surg 2002;36:217-25.) in a single-center prospective study. Method: Between October 1998 and July 2001, we used the Zenith stent graft for elective endovascular aneurysm repair in 116 patients, six of whom were women. The mean age was 75 years, and the mean aneurysm diameter was 60.3 ± 8.8 mm. Stent grafts were oversized 10% to 20% relative to computed tomographic (CT) scan-based diameter measurements. All repairs were performed in the operating room through surgically exposed femoral arteries. The results were assessed before discharge with three-phase, contrast-enhanced CT scan and plain abdominal radiograph. These studies were repeated at 1, 6, 12, and 24 months after operation. Follow-up periods ranged from 1 to 34 months. Results: No failed insertions and no conversions to open surgery occurred. The diameter of the main body of the stent graft was 28 mm or more in 73 patients (63%). Additional stents were inserted during surgery to treat kinking in eight patients (6.9%) and renal artery encroachment in two patients (1.7%). Mean fluoroscopy time was 35.1 ± 18.3 minutes, contrast load was 146 ± 53 mL (350 mg/mL), and estimated blood loss was 249 ± 407 mL. The major complication rate was 9.5%, and the minor complication rate was 10.3%. The perioperative complications were myocardial infarction in four patients, arrythmia in four patients, and pulmonary embolism, renal failure, stroke, small bowel obstruction, femoral stenosis, digital embolism, and graft limb thrombosis in one patient each. All 116 patients went home from the hospital, but one patient died 2 weeks later of a combination of pulmonary embolism and myocardial infarction. Endoleak was seen on the first CT scan in 16 patients (15%); 15 were type II, and one was type III. No endoleaks of type I or IV were seen. Additional interventions were performed for each of the following conditions: type II endoleak (n = 4), type III endoleak (n = 1), femoral clamp injury (n = 1), renal artery stenosis (n = 1), and graft limb occlusion (n = 1). One patient had acute aneurysm dilatation and rupture caused by a type II endoleak through the inferior mesenteric artery 6 months after stent graft implantation. No cases were seen of late graft occlusion, stent graft migration, stent fracture, barb fracture, or secondary endoleak. Conclusion: The Zenith device is safe, versatile, and effective in the short to medium term. Most patients need wide stent grafts (≥ 28 mm proximally and ≥ 16 mm distally) to achieve 10% to 20% oversizing to prevent type I endoleak.
AB - Purpose: The purpose of this study was to assess the short-term and mid-term results of endovascular aneurysm repair with the Zenith stent graft (J Vasc Surg 2002;36:217-25.) in a single-center prospective study. Method: Between October 1998 and July 2001, we used the Zenith stent graft for elective endovascular aneurysm repair in 116 patients, six of whom were women. The mean age was 75 years, and the mean aneurysm diameter was 60.3 ± 8.8 mm. Stent grafts were oversized 10% to 20% relative to computed tomographic (CT) scan-based diameter measurements. All repairs were performed in the operating room through surgically exposed femoral arteries. The results were assessed before discharge with three-phase, contrast-enhanced CT scan and plain abdominal radiograph. These studies were repeated at 1, 6, 12, and 24 months after operation. Follow-up periods ranged from 1 to 34 months. Results: No failed insertions and no conversions to open surgery occurred. The diameter of the main body of the stent graft was 28 mm or more in 73 patients (63%). Additional stents were inserted during surgery to treat kinking in eight patients (6.9%) and renal artery encroachment in two patients (1.7%). Mean fluoroscopy time was 35.1 ± 18.3 minutes, contrast load was 146 ± 53 mL (350 mg/mL), and estimated blood loss was 249 ± 407 mL. The major complication rate was 9.5%, and the minor complication rate was 10.3%. The perioperative complications were myocardial infarction in four patients, arrythmia in four patients, and pulmonary embolism, renal failure, stroke, small bowel obstruction, femoral stenosis, digital embolism, and graft limb thrombosis in one patient each. All 116 patients went home from the hospital, but one patient died 2 weeks later of a combination of pulmonary embolism and myocardial infarction. Endoleak was seen on the first CT scan in 16 patients (15%); 15 were type II, and one was type III. No endoleaks of type I or IV were seen. Additional interventions were performed for each of the following conditions: type II endoleak (n = 4), type III endoleak (n = 1), femoral clamp injury (n = 1), renal artery stenosis (n = 1), and graft limb occlusion (n = 1). One patient had acute aneurysm dilatation and rupture caused by a type II endoleak through the inferior mesenteric artery 6 months after stent graft implantation. No cases were seen of late graft occlusion, stent graft migration, stent fracture, barb fracture, or secondary endoleak. Conclusion: The Zenith device is safe, versatile, and effective in the short to medium term. Most patients need wide stent grafts (≥ 28 mm proximally and ≥ 16 mm distally) to achieve 10% to 20% oversizing to prevent type I endoleak.
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U2 - 10.1067/mva.2002.125032
DO - 10.1067/mva.2002.125032
M3 - Article
C2 - 12170200
AN - SCOPUS:0036675951
SN - 0741-5214
VL - 36
SP - 217
EP - 225
JO - Journal of vascular surgery
JF - Journal of vascular surgery
IS - 2
ER -