Midterm outcomes of endovascular repair with the zenith endovascular graft: does the ipsilateral limb level of the main body of the graft affect outcome?
OBJECTIVE
To clarify whether the ipsilateral limb level of the main body of the graft above or below the aortic bifurcation affects midterm outcomes of endovascular abdominal aortic aneurysm repair (EVAR) with the Zenith abdominal aortic aneurysm endovascular graft.


METHODS
The authors analyzed 70 consecutive patients treated with the Zenith endograft between 1999 and 2006 with a retrospective review of prospectively collected clinical and imaging data. Patients were divided into two groups--those in whom the ipsilateral limb of the main body was placed above the aortic bifurcation (group A, n = 34) and those in whom the ipsilateral limb of the main body was placed below the aortic bifurcation (group B, n = 36). The frequency of sac enlargement, late type I or III endoleak, and secondary intervention and freedom from major adverse events associated with an aneurysm were compared.


RESULTS
The median follow-up was 38 months (range, 1-84 months). The frequency of sac enlargement was 12% (four of 34 patients) in group A and 8% (three of 36 patients, P = .94) in group B. The frequency of late type I or III endoleak was 9% (three of 34 patients) in group A and 6% (two of 36 patients, P = .95) in group B. The frequency of secondary intervention was 15% (five of 34 patients) in group A and 6% (two of 36 patients, P = .38) in group B. Rate of freedom from major adverse events at 60-month follow-up was 62% in group A and 80% in group B (P = .54).


CONCLUSIONS
Placement of the ipsilateral limb of the main body above the aortic bifurcation should be considered as one option in patients with an inadequate iliac anatomy at this time. Further follow-up and accumulation of patients will help clarify outcomes with regard to differences in ipsilateral limb level.
Higashiura
Wataru
W
Department of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan. wataruhigashiura@hotmail.com
Sakaguchi
Shoji
S
Kichikawa
Kimihiko
K
Kubota
Yasushi
Y
Nagata
Takeshi
T
Tabayashi
Nobuoki
N
Taniguchi
Shigeki
S
Uchida
Hideo
H
D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D005548:Foreign-Body Migration; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D036542:Tomography, Spiral Computed; D016896:Treatment Outcome