Ann Surg Treat Res.  2023 Jan;104(1):34-42. 10.4174/astr.2023.104.1.34.

Anatomical feasibility of fenestrated stent graft to treat complex abdominal aortic aneurysms from a Korean single institute database

• Hyun S
• Kim H
• Mok SK
• Yun SS
• Park SC
• Kim JY

• KMID: 2537627
• DOI: http://doi.org/10.4174/astr.2023.104.1.34

Abstract

Purpose
This study aims to investigate the feasibility of Zenith Fenestrated AAA Endovascular Graft (Z-FEN, Cook Medical) from a single Korean institution database by evaluating the vascular anatomy of Korean abdominal aortic aneurysm (AAA) patients with hostile aortic neck.
Methods
This is a retrospective study on patients with AAA who underwent endovascular aortic repair (EVAR) and open surgery repair between January 2012 and December 2021 (n = 211). The anatomic characteristics of the aortic neck were evaluated using 3-dimensional reconstructed computed tomographic scans. For the juxtarenal AAA patients (n = 39), feasibility of fenestrated stent graft was evaluated under the protocol of fenestrated EVAR. For those who were not suitable for the application of Z-FEN, the reasons for unsuitability were analyzed.
Results
Among 211 AAA patients, 108 patients (51.2%) had complex aortic neck, and 39 (18.5%) had insufficient aortic neck length (<15 mm) for conventional EVAR. Of the 39 patients with juxtarenal AAAs, 13 (33.3%) were determined feasible for Z-FEN. Twenty-six patients (66.7%) were noncandidate for Z-FEN due to severe neck angulation, short aortic neck length, inadequate iliac artery anatomy, large aortic neck diameter, and severe calcification and thrombosis. Proximal aortic neck length of the non-feasible group was significantly shorter than that of the feasible group (P = 0.002).
Conclusion
Z-FEN was applicable to 33.3% of the juxtarenal AAA patients. As recent studies confirm, the effectiveness and safety of fenestrated EVAR, Z-FEN can be an option for AAA patients with short aortic neck.

Keyword

Abdominal aortic aneurysm; Eligibility determination; Endovascular procedures; Stents

Figure

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  Fig. 1 Indications of the complex aortic neck.

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  Fig. 2 Instructions for use of Z-FEN. Z-FEN, Zenith Fenestrated AAA Endovascular Graft (Cook Medical, Brisbane, QLD, Australia).

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  Fig. 3 Anatomical measurements using 3-dimensional reconstruction software straightened multiplanar reformatting mode.

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  Fig. 4 Setting clock positions using axial views of straightened multiplanar reformatting mode.

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  Fig. 5 Flow chart of patients who were assessed for the feasibility of Zenith Fenestrated AAA Endovascular Graft (Z-FEN; Cook Medical, Brisbane, QLD, Australia).

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  Fig. 6 Device planning and sizing worksheet of the design with 1 scallop and 2 small fenestrations.

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  Fig. 7 Device planning and sizing worksheet of the design with 1 large fenestration and 2 small fenestrations.

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