Long-term results of thoracic endovascular aortic repair using a low-profile stent-graft

purpose: to evaluate the long-term results associated with the zenith alpha thoracic stent-graft, which was designed to address challenging access vessel anatomy. materials and methods: a retrospective analysis was conducted of 44 consecutive patients (mean age 72.5±8.3 years; 25 men) treated in a single center between august 2010 and october 2014 with a minimum follow-up of 5 years in survivors. the zenith alpha thoracic stent-graft was used to treat thoracic aortic aneurysms (n=37), thoracoabdominal aortic aneurysm (n=5), or penetrating aortic ulcer (n=2). ten patients (23%) were American society of anesthesiologists class IV, and 9 (20%) had nonelective procedures. access vessel anatomy was demanding (mean minimum diameter 5.4 mm, tortuosity index 1.3). the primary endpoint at 5 years was ongoing clinical success (freedom from aneurysm-/procedure-related death, secondary intervention, type I or III endoleak, infection, thrombosis, aneurysm expansion, rupture, or conversion). secondary endpoints were freedom from all-cause mortality, device migration, stent fractures, fabric erosions, endoleaks, neurological events, and access vessel complications. results: the ongoing clinical success was 84% (37 of 44 patients) owing to 4 aneurysm-related deaths (9%), 3 type I or III endoleaks (1 in a deceased patient), and 1 aneurysm expansion without detectable endoleak. there were 3 access vessel complications (7%), and no postoperative neurological events. migration was observed in 2 cases (5%). there were no stent fractures or fabric tears. conclusion: despite the alterations in stent-graft design and material to reduce profile, the zenith alpha thoracic stent-graft showed favorable long-term results even in multimorbid patients with demanding iliac anatomy.