Conformability and Efficacy of the Zenith Spiral Z Leg Compared with the Zenith Flex Leg in Endovascular Abdominal Aortic Aneurysm Repair.

Background: The aim of this study is to compare the outcome of endovascular abdominal aortic aneurysm repair (EVAR) using the Zenith Spiral Z abdominal aortic aneurysm iliac leg (ZSLE) versus the Zenith Flex abdominal aortic aneurysm iliac leg (TFLE).

Methods: Patients undergoing EVAR using TFLE or ZSLE between October 2009 and December 2017 were retrospectively reviewed. Clinical end points were freedom from limb-related complications and change in arterial tortuosity indexes. Limb-related complication was defined as limb stenosis or occlusion, stent kink, stent disconnection, and type 1b endoleak. Tortuosity indexes were measured on the preoperative and postoperative computed tomography and compared.

Results: A total of 56 patients (11 female, average age 78.5 ± 5.5 years), 111 limbs, were enrolled. One patient was treated using aortouni-iliac device. TFLE was deployed in 43 limbs (22 patients) and ZSLE in 68 limbs (34 patients). Average follow-up was 43.6 ± 27.6 months. During follow-up, 8 limb-related complications occurred in the TFLE group and 2 in the ZSLE group. Freedom from limb-related complications at 3 years was 84.4% in the TFLE group and 96.1% in the ZSLE group (P = 0.039). There was no statistically significant difference between the TFLE and the ZSLE group in the aortoiliac tortuosity change (TFLE versus ZSLE -6.1 ± 5.8 vs. -4.9 ± 6.4, P = 0.324). However, there was significance in the iliac tortuosity change (-7.4 ± 11.7 vs. -3.0 ± 7.9, P = 0.022).

Conclusions: Spiral Z leg showed less occurrence of limb-related complications and less iliac artery tortuosity index change compared to Zenith Flex leg. The spiral Z leg provided better conformability as a stent-graft limb.