Adjunctive Iliac Stents Reduce the Risk of Stent-Graft Limb Occlusion Following Endovascular Aneurysm Repair With the Zenith Stent-Graft

• DOI: 10.1583/09-2854.1
• Publication Date: 2010-03-04T02:20:24Z
• Authors: Olufemi A. Oshin; Robert K. Fisher; Leith A. Williams; John A. Brennan; Geoffrey L. Gilli...; S. Rao Vallabhaneni; Richard G. McWill...
• Keywords: Aged, 80 and over; Male; Chi-Square Distribution; Time Factors; Graft Occlusion, Vascular; Kaplan-Meier Estimate; Middle Aged; Prosthesis Design; Aortography; Iliac Artery; Risk Assessment; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; 03 medical and health sciences; 0302 clinical medicine; Risk Factors; Humans; Female; Stents; Aged; Aortic Aneurysm, Abdominal; Retrospective Studies

To determine whether the introduction of a policy of adjunctive stent insertion based on preoperative CT assessment or completion angiography reduced the incidence of limb occlusion after stent-graft implantation for endovascular aneurysm repair (EVAR).A tertiary referral unit's endovascular database was retrospectively interrogated to compare the incidence of endograft limb occlusion in Zenith grafts following the introduction of a policy of selective adjunctive stent insertion. Group A included 288 limbs at risk in 146 patients (134 men; mean age 74+/-8 years) treated prior to August 2005 in whom adjunctive stents were inserted on an ad hoc basis only. Group B included 293 limbs at risk in 149 patients (127 men; mean age 76+/-7 years) treated after this date in whom a more aggressive adjunctive stenting strategy was adopted. Kaplan-Meier analysis was employed to compare outcomes.In total, 295 patients underwent EVAR involving 581 iliac vessels, of which 11 (1.8%) occluded at a median of 24 months (0-27). Of 65 limbs extended into the external iliac segment, 5 (7.6%) subsequently occluded; in the remaining 516 limbs, there were 6 (1.1%) occlusions (p = 0.004). Across the study group, 38 (6.5%) adjunctive stents were deployed in limbs deemed at risk; 1 (2.6%) of these occluded. In the remaining 543 unstented limbs, 10 (1.8%) occlusions occurred (p = 0.15). There were 11 occlusions in group A, in which 5 (1.7%) adjunctive stents had been deployed, but none in group B, which had received 33 (11.2%) stents (p<0.0001). Kaplan-Meier survival curves identified primary patency rates at 36 months of 96% and 100%, respectively (p = 0.001).Adjunctive stenting significantly reduces the risk of postoperative stent-graft limb occlusion without obvious compromise to the aneurysm repair.