Clinical Study
A Decade of Outcomes and Predictors of Sac Enlargement after Endovascular Abdominal Aortic Aneurysm Repair Using Zenith Endografts in a Japanese Population

https://doi.org/10.1016/j.jvir.2014.01.017Get rights and content

Abstract

Purpose

To present 10-year outcomes and risk factors for sac enlargement after endovascular aneurysm repair (EVAR) using the Zenith AAA Endovascular Graft (Cook, Inc, Bloomington, Indiana) in a Japanese population.

Material and Methods

During the period 1999–2011, 127 patients underwent elective EVAR using Zenith endografts at a single institution. A retrospective investigation looked at initial rates of technical success and complications, 10-year rate of freedom from all-cause and aneurysm-related mortality, freedom from secondary intervention and sac enlargement, and risk factors for second intervention and sac enlargement.

Results

The median age of the patients was 78 years, and the median follow-up time was 43 months. The initial technical success rate was 98.4% (125 of 127 patients). Major adverse events occurred in 7 of 127 (5.5%) patients. Rates of freedom from all-cause and aneurysm-related mortality at 1, 3, 5, and 10 years were 95%, 87%, 77%, and 39% (all-cause mortality) and 100%, 100%, 99%, and 93% (aneurysm-related mortality). Rates of freedom from secondary intervention at 1, 3, 5, and 10 years were 97%, 91%, 88%, and 70%. Rates of primary freedom from sac enlargement at 1, 3, 5, and 10 years were 99%, 87%, 75%, and 67%. Multivariate analysis revealed aneurysm sac diameter as an independent risk factor for a secondary intervention. Preoperative sac diameter combined with an angulated short (AS) proximal neck was a risk factor for sac enlargement.

Conclusions

The 10-year results of EVAR using Zenith endografts in a Japanese population were comparable to results from Western countries. Larger aneurysms and AS neck were predictors of sac enlargement after EVAR.

Section snippets

Patients

Between July 1999 and August 2011, 127 patients underwent elective EVAR with Zenith endografts. This was a retrospective review of prospectively collected clinical follow-up and imaging data and did not require institutional review board approval according to our institutional guidelines. All patients provided written informed consent to participate in all procedures associated with the study. The median age of patients was 78 years (range, 55–91 y), and the median follow-up time was 43 months

Results

Friendly necks were present in 83 (65%) patients, and hostile necks were present in 44 (35%) patients. Among patients with hostile necks, 31 (25%) had one hostile feature, and 13 (10%) had two hostile features. Table 2 summarizes the demographics and anatomic characteristics of the patients. There were 5 patients lost to follow-up, and 23 patients did not undergo CT imaging at the final visit.

Discussion

This article describes the long-term follow-up results of our single-center experience with the Zenith endograft as elective treatment for AAAs and aortoiliac aneurysms in a Japanese population. Overall 5-year and 10-year survival rates were 77% and 39%, respectively, and 5-year and 10-year rates of freedom from aneurysm-related mortality were 99% and 93%, respectively. Most deaths were unrelated to aneurysms. This finding is comparable to previously reported aneurysm-related mortality rates of

References (22)

Cited by (18)

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    For the hostile neck, patients with fewer hostile neck parameters had a greater chance of late AAA shrinkage (P = .05).19 Patients with two features of a hostile neck had a significantly lower rate of freedom from sac growth compared with patients with one feature and non-HNA (P < .001).29 For the total AAA volume and flow-lumen volume, both studies had described significant, but contradicting, associations with AAA sac remodeling.21,27

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None of the authors have identified a conflict of interest.

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