Outcomes of iCAST Bridging Stents in Zenith Fenestrated Endografts – A Single Center Experience

Background

To evaluate the outcomes of patients undergoing placement of balloon-expandable iCAST bridging stents during fenestrated endovascular aortic aneurysm repair (FEVAR) with Zenith Fenestrated Endografts (ZFENs) and to identify preoperative and perioperative risk factors for stent-related complications.

Methods

Between 2012 and 2020, 207 patients underwent FEVAR using unmodified ZFEN with bridging iCAST-covered stents to visceral target vessels. We collected patient demographics and operative variables from the index repair. We collected long-term follow-up data for endoleaks, branch patency, and reintervention. We defined branch stent complications as malalignment, kinking, occlusion, or endoleak requiring intervention as determined by surveillance imaging studies. We compared variables from the index operation in those patients with stent complications to those patients without stent complications to identify significant risk factors.

Results

Patients in our cohort were predominantly male (n = 158, 76.3%), White (n = 199, 96.1%), and demonstrated cardiovascular comorbidity. The majority of repairs were for juxtarenal aortic aneurysms (n = 149, 72%) with the remainder of repairs extending further cephalad. We identified 23 patients with bridging stent complications during follow-up that required reintervention. Brachial access was more frequently used in the complication group (34.8% vs. 15.8%, P = 0.0251). A significantly higher proportion of patients in the complication group was treated for extent IV thoracoabdominal aortic aneurysms (TAAAs) (17.8% vs. 5.4%, P = 0.0316). Additional patient characteristics and perioperative factors are compared between the branch complications and no branch complications groups. An intervention-free patency Kaplan-Meier plot is presented.

Conclusion

Here, we present a large single institution experience with iCAST branch stents during FEVAR using unmodified ZFEN and risk factors for stent-related complications. Patients with branch complications were more likely to have brachial access and more extensive aneurysm repair. Most branch complications were identified within the first 2 years, with half of reinterventions occurring within 7.5 months of the index operation.