A Decade of Outcomes and Predictors of Sac Enlargement after Endovascular Abdominal Aortic Aneurysm Repair Using Zenith Endografts in a Japanese Population

Purpose: To present 10-year outcomes and risk factors for sac enlargement after endovascular aneurysm repair (EVAR) using the Zenith, AAA Endovascular Graft (Cook, Inc, Bloomington, Indiana) in a Japanese population. Material and Methods: During the period 1999-2011, 127 patients underwent elective EVAR using Zenith endografts at a single institution. A retrospective investigation looked at initial rates of technical success and complications, 10-year rate of freedom from all-cause and aneurysm-related mortality, freedom from secondary intervention and sac,enlargement, and risk factors for second intervention and sac enlargement. Results: The median age of the patients was 78 years, and the median follow-tip time was 43 months. The initial technical success rate was 98.4% (123 of 127 patients). Major adverse events occurred in 7 of 127 (5.5%) patients. Rates of freedom from all-cause and aneurysm-related mortality at 1, 3, 5, mid 10 years were 95%, 87%, 77%, and 39% (all-cause mortality) and 100%, 100%; 99%, and 93% (aneurysm-related mortality). Rates of freedom from secondary intervention at 1, 3 5, and 10 years were 97%, 91%, 88%, and 70%. Rates of primary freedom from sac enlargement at 1, 3, 5, and 10 years were 99%, 87%, 75%, and 67%. Multivariate analysis revealed aneurysm sac diameter as an independent risk factor for a secondary intervention. Preoperative sac diameter combined with an angulated short (AS) proximal neck was a risk factor for sac enlargement. Conclusions: The 10-year results of EVAR using Zenith endografts in a Japanese population were comparable to results from Western countries. Larger aneurysms and AS neck were predictors of sac enlargement after EVAR.