Long-term results after endovascular abdominal aortic aneurysm repair using the Cook Zenith endograft

J Vasc Surg. 2011 Jul;54(1):48-57.e2. doi: 10.1016/j.jvs.2010.12.068. Epub 2011 Apr 2.

Abstract

Objective: This study assessed the long-term outcome of patients with abdominal aortic and aortoiliac aneurysms treated with the Cook Zenith endovascular graft (Cook Inc, Bloomington, Ind).

Methods: Between September 1998 and October 2003, 143 patients underwent elective endovascular aneurysm repair (EVAR) using the Cook Zenith endograft. Data from these patients were reviewed from a prospective database in October 2008. Primary outcome measures were overall survival, intervention-free survival, and freedom from aneurysm rupture. Secondary outcome measures were early and late postoperative complications, including endoleaks.

Results: Mean follow-up was 66.4 months (range, 1.9-121.0 months). Overall survival was 72.1% at the 5-year follow-up and 50.9% at the 8-year follow-up. Intervention-free survival was 77.1% at 5 years and 63.8% at 8 years. There were no reintervention-related deaths. Six patients had a late aneurysm rupture, which was fatal in three. Freedom from aneurysm rupture was 98.1% at 5 years and 91.0% at 8 years. Late complications occurred throughout the follow-up period, with a tendency for aneurysm rupture and surgical conversion to occur at a later stage in the follow-up period. Aneurysm sac enlargement during follow-up was associated with late aneurysm rupture and with the need for reintervention.

Conclusion: Elective EVAR using the Cook Zenith endograft provides excellent results through a mean follow-up of >5 years. There is a low aneurysm-related mortality and an acceptable rate of postoperative complications and reinterventions. The occurrence of late complications throughout the follow-up period stresses the need for continued postoperative surveillance in EVAR patients.

MeSH terms

  • Aged
  • Aortic Aneurysm, Abdominal / diagnostic imaging
  • Aortic Aneurysm, Abdominal / mortality
  • Aortic Aneurysm, Abdominal / surgery*
  • Aortic Rupture / etiology
  • Aortic Rupture / mortality
  • Aortic Rupture / surgery
  • Aortography / methods
  • Belgium
  • Blood Vessel Prosthesis Implantation / adverse effects
  • Blood Vessel Prosthesis Implantation / instrumentation*
  • Blood Vessel Prosthesis Implantation / mortality
  • Blood Vessel Prosthesis*
  • Elective Surgical Procedures
  • Endoleak / etiology
  • Endoleak / surgery
  • Endovascular Procedures / adverse effects
  • Endovascular Procedures / instrumentation*
  • Endovascular Procedures / mortality
  • Female
  • Foreign-Body Migration / etiology
  • Graft Occlusion, Vascular / etiology
  • Graft Occlusion, Vascular / surgery
  • Humans
  • Iliac Aneurysm / diagnostic imaging
  • Iliac Aneurysm / mortality
  • Iliac Aneurysm / surgery*
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Prosthesis Design
  • Reoperation
  • Risk Assessment
  • Risk Factors
  • Stents*
  • Survival Rate
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome