title: Anatomical Suitability of the Zenith Off-the-Shelf (p-Branch) Endograft in Juxtarenal Aortic Aneurysms Previously Treated Using the Chimney Technique.
abstract: To examine the suitability of the Zenith off-the-shelf (p-branch) endograft in patients with juxta- or pararenal abdominal aortic aneurysms (J/PRAA) previously treated with endovascular aneurysm repair incorporating the chimney technique (chEVAR).
  
  
  
  Between January 2012 and December 2014, high-resolution computed tomography angiograms and clinical data from 50 patients (mean age 79 years; 45 men) with J/PRAAs treated with chEVAR were retrospectively reviewed. Primary anatomical suitability was evaluated according to the Investigational Device Exemption protocol for the Zenith p-branch endograft in a dedicated 3-dimensional vascular workstation. Secondary suitability was defined as any additional intervention needed to overcome adverse anatomical conditions at the access vessels. The Zenith p-branch endograft is available in 2 configurations (A and B), with the main difference being the distance between the superior mesenteric artery (SMA) and the renal fenestrations.
  
  
  
  The p-branch endograft showed a primary suitability of 54% (n=27). Each configuration was suitable in 18 (36%) patients. Main anatomical limitations were the clock position of the left renal artery (LRA; n=7, 14%), the distance between the SMA and LRA (A: n=16, 32%; B: n=16, 32%), and significantly narrowed or calcified iliac arteries. If additional interventions at the access vessels were employed, a secondary suitability of 64% (n=32) could be achieved.
  
  
  
  In this specific group of patients treated with chEVAR, the Zenith p-branch system would be suitable in about half of the patients, which could be raised to two-thirds with ancillary access vessel procedures. A prospective clinical study is warranted to evaluate these results.
authors.affiliation: 1 Department of Vascular Surgery, University of Münster, Germany.|2 St. Franziskus Hospital Münster, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Schroeder
authors.affiliation: 1 Department of Vascular Surgery, University of Münster, Germany.|2 St. Franziskus Hospital Münster, Germany.
authors.forename: Konstantinos P
authors.initials: KP
authors.lastname: Donas
authors.affiliation: 1 Department of Vascular Surgery, University of Münster, Germany.|2 St. Franziskus Hospital Münster, Germany.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Stavroulakis
authors.affiliation: 1 Department of Vascular Surgery, University of Münster, Germany.|2 St. Franziskus Hospital Münster, Germany.
authors.forename: Arne
authors.initials: A
authors.lastname: Stachmann
authors.affiliation: 1 Department of Vascular Surgery, University of Münster, Germany.|2 St. Franziskus Hospital Münster, Germany.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Torsello
authors.affiliation: 1 Department of Vascular Surgery, University of Münster, Germany.|2 St. Franziskus Hospital Münster, Germany.
authors.forename: Theodosios
authors.initials: T
authors.lastname: Bisdas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
keywords: abdominal aortic aneurysm; branched stent-graft; chimney technique; endovascular aneurysm repair; juxtarenal aortic aneurysm; off-the-shelf stent-graft; p-branch; stent-graft