Endovascular Aneurysm Repair with Zenith Alpha Abdominal Stent-Graft in Hostile and Nonhostile Aortic Neck Anatomies

Abstract

Background: The aim of this study was to evaluate early and 5-year outcomes of endovascular aneurysm repair (EVAR) with Zenith Alpha Abdominal in the context of a multicenter regional retrospective registry comparing patients with hostile and nonhostile aortic necks.

Methods: A retrospectively maintained dataset identified all consecutive patients with Abdominal Aortic Aneurysms underwent elective EVAR with implantation of a Zenith Alpha Abdominal in 7 centers between January 2016 and December 2022. Two-hundred-twenty-eight patients have been included in the present study: 98 (43%) with a hostile neck (Group HN), and 130 (57%) with a no-hostile neck (Group n-HN). Early (30-day) outcomes in terms of technical and clinical successes were assessed and compared. Estimated 5-year outcomes were evaluated and compared in terms of survival, freedom from type I/III endoleak, freedom from surgical conversion, freedom from limb graft occlusion, and freedom from any device-related reintervention(s) by using life-table analysis (Kaplan-Meier curves) and log-rank test.

Results: Female gender was more frequent in Group HN (15.3% vs. 5.3%, P = 0.01). Thirty-day technical success rate was 96.9% in Group HN, and 100% in Group n-HN (P = 0.08), while 30-day clinical success rate was 96.9% in Group HN, and 99.2% in Group n-HN (P = 0.21). Overall median follow-up period was 32.1 months [InterQuartile Range 14-47]. Estimated 5-year survival rates were comparable (67.1% in Group HN, and 77.9% in Group n-HN, P = 0.47). During the follow-up no endoleak type III have been detected in both groups. At 5 years there were no differences between the two groups in terms of freedom from surgical conversion (95.1% Group HN vs. 96.7% Group n-HN; P = 0.71, log-rank 0.14), freedom from limb graft occlusion (95.7% Group HN vs. 93.5% Group n-HN; P = 0.58, log-rank 0.29), and freedom from any device-related reintervention(s) (70.5% Group HN vs. 89.7% Group n-HN; P = 0.19, log-rank 1.72). Starting from the third year of follow-up, hostile neck affected type I endoleak rate (70.2% Group HN vs. 98.4% Group n-HN; P = 0.008, log-rank 6.96). Female gender was the only factor affecting type I endoleak onset during the follow-up (P = 0.02; log-rank = 5.44).

Conclusion: In the present multicenter experience hostile neck was more frequent in female patients. Hostile neck affected type I endoleak rates in patients undergoing Zenith Alpha Abdominal implantation starting from the third year of follow-up from the index procedure.