Late Complications After Endovascular Aneurysm Repair Using the Zenith Stent Graft

Jade Hiramoto, MD, Linda Reilly, MD, Darren Schneider, MD, Nayan Sivamurthy, MD, Joseph Rapp, MD and Timothy Chuter, MD
Division of Vascular Surgery, UCSF, San Francisco, CA

Objective: To assess the long-term performance of the bifurcated Zenith stent-graft.
Methods: 329 patients (303 men and 26 women) underwent elective endovascular abdominal aortic aneurysm (AAA) repair using bifurcated Zenith stent-grafts between October 1998 and December 2005. Follow-up included routine contrast-enhanced computed tomography (CT) and multi-view abdominal x-rays at 1, 6, 12 months, and yearly thereafter. Data on late-occurring (>30 days after stent-graft implantation) complications and interventions were collected prospectively.
Results: Of the original 329 patients, 90 have since died, resulting in a mean follow-up of 2.17 years (range one month to 6.98 years). Eight of 329 (2.4%) patients experienced a late graft-related complication at an average of 1.12 years after stent-graft placement (range 40 days-3.98 years). Three of these patients (0.9%) died from causes related to malfunction of the stent-graft: one each from aneurysm rupture, stent-graft infection, and infection of a femoral-femoral bypass graft placed after limb occlusion. The other 5 late complications included: graft limb occlusion in 1, kinking (without occlusion) in 1, type III endoleak in 2, and renal artery occlusion in 1. Excluding coil embolization for type II endoleak, there were 5 late re-interventions, each corresponding to one of the above complications. These interventions were: femoral-femoral bypass in 1, stenting of a graft limb in 1, stent-grafting of a graft limb in 2, and stenting of a renal artery in 1. There were no instances of late re-intervention for type 1 endoleak or stent-graft migration.
Conclusions: Late-occurring failures of stent-graft attachment, structure, or function are rare following endovascular aortic aneurysm repair with the Zenith stent-graft.