title: Midterm outcomes of endovascular repair with the zenith endovascular graft: does the ipsilateral limb level of the main body of the graft affect outcome?
abstract: 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.
authors.affiliation: Department of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan. wataruhigashiura@hotmail.com
authors.forename: Wataru
authors.initials: W
authors.lastname: Higashiura
authors.forename: Shoji
authors.initials: S
authors.lastname: Sakaguchi
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Kichikawa
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Kubota
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nagata
authors.forename: Nobuoki
authors.initials: N
authors.lastname: Tabayashi
authors.forename: Shigeki
authors.initials: S
authors.lastname: Taniguchi
authors.forename: Hideo
authors.initials: H
authors.lastname: Uchida
mesh_terms: 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