Early and Midterm Outcomes of Endovascular Aneurysm Repair With Zenith Alpha Abdominal Stent-Graft: Results From a Multicenter Retrospective Tuscany Registry
Authors: Troisi Nicola , Pulli Raffaele , Donato Gianmarco de , Adami Daniele , Bertagna Giulia , Michelagnoli Stefano , Berchiolli Raffaella , Canovaro Francesco , Torri Lorenzo , Pratesi Carlo , Fargion Aaron , Speziali Sara , Di Domenico Rossella , Petroni Rachele , Palasciano Giancarlo , Pasqui Edoardo , Galzerano Giuseppe , Molino Cecilia , Giuseppe Anzaldi Manfredi , Invernizzi Claudio , Loschiavo Vincenzo , Chisci Emiliano , Caneva Patrizia Dalla , Ercolini Leonardo , Lazzeri Elisa , Filippi Federico , Panzano Claudia 
Published: August 2023

Purpose: Zenith Alpha Abdominal (Cook Medical, Bloomington, IN, USA) is one of the new-generation low-profile stent-grafts with demonstrated satisfactory early and midterm clinical outcomes for endovascular treatment of abdominal aortic aneurysms (AAAs). The aim was to evaluate early and midterm results of this device in the framework of a multicenter regional retrospective registry, with the analysis of morphological factors affecting outcomes, including different limb configurations. Materials and methods: Between January 2016 and November 2021, 202 patients with AAA underwent elective endovascular aneurysm repair (EVAR) with implantation of a Zenith Alpha Abdominal in 7 centers. Early (30 day) outcomes in terms of technical and clinical success were assessed. Estimated 5 year outcomes were evaluated in terms of survival, freedom from type I/III endoleak, freedom from surgical conversion, freedom from limb graft occlusion, freedom from any device-related reintervention, and graft infection evaluation by life-table analysis (Kaplan–Meier test). A comparative analysis between different limb configurations (Zenith Spiral Z AAA iliac legs, codes ZISL vs ZSLE) was performed in terms of limb graft occlusion. Results: The 30 day technical and clinical success rates were 97.5% and 99.5%, respectively. Median follow-up period was 25.5 months (interquartile range [IQR]: 12–43.25). The 5 year survival rate was 73.6%. The estimated 5 year outcomes in terms of freedom from type I/III endoleak, freedom from surgical conversion, freedom from limb graft occlusion, freedom from any device-related reintervention, and freedom from graft infection were 88.6% (95% CI [confidence interval]: 83.4%–93.1%), 95.8% (95% CI: 92.7%–97.1%), 93.6% (95% CI: 90.2%–96.8%), 87% (95% CI: 83.3%–91.6%), and 97.7% (95% CI: 95.1%–98.9%), respectively. About limb configuration, no differences were found in terms of 5 year freedom from limb graft occlusion (ZSLE 93.4% [95% CI: 89.8%–95.5%] vs ZISL 94.3% [95% CI: 90.1%–95.9%], p=0.342; log-rank 0.903). Conclusion: Zenith Alpha Abdominal in elective EVAR offered satisfactory early and 5 year outcomes with low complication rates. Limb graft occlusion continued to be an issue. Limb configuration did not affect outcomes. Clinical Impact The authors describe satisfactory early and 5 year outcomes of Zenith Alpha Abdominal in elective endovascular aortic repair in the framework of a multicenter regional retrospective registry. At 5 years freedom from type I endoleak was 88.6%, and rate of endograft infections and conversions to open repair were very low. in the present study. Hot topic about about Zenith stent-graft still remains the limb graft occlusion with a 30-day overall rate of 2%, and estimated 5-year freedom from limb graft occlusion of 93.6%. Limb graft configuration did not affect limb graft occlusion rate. A standardized protocol including iliac stenting should be adopted to reduce kimb graft occlusion.