Endograft Conformability in Fenestrated Endovascular Aneurysm Repair for Complex Abdominal Aortic Aneurysms

Abstract

Purpose: To compare the impact of 2 commercially available custom-made fenestrated endografts on patient anatomy. Materials and Methods: The records of 234 patients who underwent fenestrated endovascular aneurysm repair for abdominal aortic aneurysm from March 2002 to July 2016 in 2 hospitals were screened to identify those who had pre- and postoperative computed tomography angiography assessments with a slice thickness of ≤2 mm. The search identified 145 patients for further analysis: 110 patients (mean age 72.4±7.1 years; 94 men) who had been treated with the Zenith Fenestrated (ZF) endograft and 35 patients (mean age 72.3±7.3 years; 30 men) treated with the Fenestrated Anaconda (FA) endograft. Measurements included aortic diameters at the level of the superior mesenteric artery (SMA) and renal arteries, target vessel angles, target vessel clock positions, and the target vessel tortuosity index. Variables were tested for inter- and intraobserver agreement. Results: There was a good agreement between observers in all tested variables. The native anatomy changed in both groups after endograft implantation. In the ZF group, changes were seen in the angles of the celiac artery (p=0.012), SMA (p=0.022), left renal artery (LRA) (p<0.001), and the right renal artery (RRA) (p<0.001); the aortic diameter at the SMA level (p<0.001); and the LRA (p<0.001) and RRA (p<0.001) clock positions. In the FA group, changes were seen in the angles of the LRA (p=0.001) and RRA (p<0.001) and in the SMA tortuosity index (p=0.044). Between group differences in changes were seen for the aortic diameters at the SMA and renal artery levels (p<0.001 for both) and the LRA clock position (p=0.019). Conclusion: Both custom-made fenestrated endografts altered vascular anatomy. The data suggest a higher conformability of the Fenestrated Anaconda endograft compared with the Zenith Fenestrated.

Abdominal Aortic Aneurysm: Can the Anaconda™ Custom-Made Device Deliver? An International Perspective

“…Finally, de Niet et al ( 29 ) also compared Anaconda™ against Zenith. This 14-year study of 145 patients sought to evaluate the conformability of both the Anaconda™ ( n = 35) and Zenith ( n = 110) endografts.…”

“…The influence of different graft designs on aortic anatomy after implantation was assessed. The procedural details of both devices can be seen in Figure 8 [reproduced from de Niet et al ( 29 )]. The slight difference in procedural time was insignificant, but, on the other hand, both contrast volume and estimated blood loss were significantly less with the Anaconda™ graft.…”

“…In addition, the majority of devices used were bifurcated and with two fenestrations in both groups. Interestingly, 36 adjunctive procedures were required in 33 Zenith patients compared with 11 in 10 Anaconda™ patients, shedding light on the Anaconda™ more advanced delivery system ( 29 ).…”

Long-Term Survival and Quality of Life After Fenestrated Endovascular Repair for Complex Abdominal Aortic Aneurysms

“…A single-center cohort study was conducted based on prospectively collected data on complex AAA patients treated with FEVAR in a tertiary care facility in the Netherlands. 14 Patients who underwent FEVAR between 2002 and 2016 because of complex AAA configuration were extracted from the Electronic Health Records. This specific cohort was used to pursue a minimal follow-up of 5 years.…”

Endovascular solutions for abdominal aortic aneurysms: A comparative review of clinical outcomes with custom-made endografts

“…Finally, two smaller additional studies reported no 30-day deaths. 24,25 A summary of the finding in this subsection can be found in Table 1 alongside results from additional Anaconda™ studies [26][27][28][29][30][31] as well as studies investigating Zenith [32][33][34][35] (to be discussed in the section 'Competitor devices'). Saratzis et al 12 Anaconda™ N = 51 16 0 3.9 Stella et al 13 Anaconda™ N = 100 23 3.3 3.3 Rödel et al 14 Anaconda™ N = 61 24 3.3 9.8 Freyrie et al 18 Anaconda™ N = 787 − 1.2 − Karkos et al 15 Anaconda™ N = 68 29 0 20 Rödel et al 24 Anaconda™ N = 36 40 0 22 Rolls et al 25 Anaconda™ N = 13 12 0 − Freyrie et al 17 Anaconda™ N = 177 33 1.1 3.6 Dijkstra et al 16 Anaconda™ N = 25 -0 2 0 Gallitto et al 26 Anaconda™ N = 26 12 7.7 − Shahverdyan et al 27 Anaconda™ N = 48 24 4 6 Kotelis et al 28 Anaconda™ N = 39 − 8 1 8 Colgan et al 29 Anaconda™ N = 101 − 3 − Midy et al 30 Anaconda™ N = 86 24 7 21.7 de Niet et al 31 Anaconda™ N = 29 -14 19 Midy et al 19 Anaconda™ N = 176 -1.7 5.1 Tigkiropolous et al 20 Anaconda™ N = 271 72 1.1 21 de Niet et al 23 Anaconda™ N = 335 − 4.2 15.8 Pini et al 21 Anaconda™ N = 127 21 4 9 Isernia et al 22 Anaconda™ N = 260 54 0.8 5.2 Verzini et al 32 Zenith N = 610 99 0.8 7.2 Vaaramaki et al 33 Zenith N = 282 − 1.8 7 Kawamata et al 34 Zenith N = 95 50 0 23.2 Oderich et al 35 Zenith N = 67 59 1.5 10.4…”