Comparative Outcomes of Physician-modified Endografts and Zenith Fenestrated Endografts in Juxtarenal Abdominal Aortic Aneurysms
Recommended Citation
Halabi M, Chamseddine H, Shepard A, Kabbani L, Nypaver T, Weaver M, Kavousi Y, Onofrey K, Gould J, Peshkepija A. Comparative Outcomes of Physician-modified Endografts and Zenith Fenestrated Endografts in Juxtarenal Abdominal Aortic Aneurysms. J Vasc Surg 2025; 82:e81.
Document Type
Conference Proceeding
Publication Date
9-1-2025
Publication Title
J Vasc Surg
Abstract
Objectives: To evaluate the early outcomes of physician modified endografts (PMEGs) vs Zenith fenestrated (ZFEN) grafts for juxtarenal aneurysms (JAAA). Methods: A retrospective review was conducted for all patients who underwent endovascular repair of a JAAA with either PMEG or ZFEN at a quaternary care center between 2014 and 2024. Demographic data, procedural metrics, and postoperative outcomes were collected. Technical success was defined on an intention-to-treat basis. Descriptive statistics summarized baseline characteristics, operative variables, and follow-up outcomes. Bivariate analysis was performed to compare perioperative outcomes between the PMEG and ZFEN groups. Results: A total of 60 patients underwent fenestrated endovascular aortic repair for JAAA using either PMEG (n = 25) or ZFEN (n = 35). Patients treated with ZFEN had a higher comorbidity burden, including diabetes (66% vs 24%; P =.001), hypertension (97% vs 76%; P =.012), hyperlipidemia (97% vs 68%; P =.002), and chronic kidney disease (71% vs 6%; P <.001). Operative metrics demonstrated comparable median procedure times between groups (273 minutes vs 270 minutes; P =.382). PMEG cases had significantly longer fluoroscopy times (86 minutes vs 58.5 minutes; P =.011) but total radiation dose was similar between the two groups (Table I). Technical success was 100% in both cohorts. At 30 days, pneumonia (12% vs 0%; P =.035) and acute kidney injury (28% vs 6%; P =.017) were more frequent in the PMEG group. Other postoperative outcomes, including spinal cord ischemia, stroke, and reintervention, were similar. No 30-day mortality occurred in either group. Type Ia endoleak occurred more frequently in the ZFEN group (5.5% vs 0%; P =.809) (Table 2). At 1 year, mortality was higher in the ZFEN group (11% vs 4%; P =.390), while reintervention rates remained similar (8% vs 6%; P =.557). Conclusions: Both PMEG and ZFEN demonstrated high technical success rates for JAAA repair, with similar procedural times and no 30-day mortality. ZFEN use is limited by strict instruction for use criteria and long delivery times, making PMEG a timely alternative for anatomically unsuiTable cases. Long-term follow-up is needed to evaluate durability and reintervention rates between techniques. [Formula presented] [Formula presented]
Volume
82
First Page
e81
