PMID- 32886245 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20201025 IS - 2520-8934 (Electronic) IS - 2520-8934 (Linking) VI - 3 IP - 1 DP - 2020 Oct 25 TI - Superior mesenteric artery outcomes after large fenestration strut relocation with the Zenith Fenestrated endoprosthesis. PG - 54 LID - 10.1186/s42155-020-00148-9 [doi] LID - 54 AB - BACKGROUND: The Zenith(R) Fenestrated (ZFen) stent-graft is frequently configured with a strut-spanning large fenestration for superior mesenteric artery (SMA) incorporation. This has led some to relocate struts to create a strut-free fenestration and place a bridging stent. The aim of this study was to compare SMA outcomes with and without large fenestration strut relocation. METHODS: We performed a retrospective review of a prospective database of patients undergoing fenestrated endovascular repair with ZFen between 2013 and 2019. Those with SMA incorporation using large fenestrations were included and separated into strut relocation (SR) and no relocation (NR) groups. Endpoints included procedural metrics, technical success, major adverse events, and target-vessel instability. RESULTS: A total of 121 patients (77% male; mean age 76.1 +/- 7.1 years) met inclusion criteria, including 94 with SR (78%) and 27 with NR (22%). A total of 369 target-vessels were incorporated, with a mean of 3.0 +/- 0.2 per patient, and no differences between groups. Mean operative time, contrast volume, estimated blood loss, fluoroscopy time and radiation dose were lower (p < 0.001) with SR, attributed to increased experience with time. Overall technical success (SR: 100%, NR: 96%, p = 0.22) was 99%. At a mean follow-up of 32 months, there were two endovascular interventions for mesenteric ischemia. One resulted in SMA dissection requiring bypass in the NR group, the other was successful ballooning of the bridging stent with symptom resolution in the SR group. CONCLUSIONS: Relocating the spanning struts does not negatively impact procedural metrics or midterm outcomes. It may facilitate future endovascular interventions. FAU - Mirza, Aleem K AU - Mirza AK AD - Section of Vascular and Endovascular Surgery, Minneapolis Heart Institute, Abbott Northwestern Hospital, 920 E. 28th Street, Suite 200, Minneapolis, MN, 55407, USA. akhm88@gmail.com. FAU - Sullivan, Timothy M AU - Sullivan TM AD - Section of Vascular and Endovascular Surgery, Minneapolis Heart Institute, Abbott Northwestern Hospital, 920 E. 28th Street, Suite 200, Minneapolis, MN, 55407, USA. FAU - Skeik, Nedaa AU - Skeik N AD - Section of Vascular and Endovascular Surgery, Minneapolis Heart Institute, Abbott Northwestern Hospital, 920 E. 28th Street, Suite 200, Minneapolis, MN, 55407, USA. FAU - Manunga, Jesse AU - Manunga J AD - Section of Vascular and Endovascular Surgery, Minneapolis Heart Institute, Abbott Northwestern Hospital, 920 E. 28th Street, Suite 200, Minneapolis, MN, 55407, USA. LA - eng PT - Journal Article DEP - 20201025 PL - Switzerland TA - CVIR Endovasc JT - CVIR endovascular JID - 101738484 PMC - PMC7474034 OTO - NOTNLM OT - Fenestrated endovascular aortic repair (FEVAR) OT - Large fenestration OT - Physician-modified endograft (PMEG) OT - Stent strut relocation OT - Superior mesenteric artery (SMA) OT - Type I/IIIc endoleak OT - Zenith Fenestrated AAA Endovascular(R) (ZFen) COIS- The authors declare that they have no competing interests. EDAT- 2020/09/05 06:00 MHDA- 2020/09/05 06:01 PMCR- 2020/10/25 CRDT- 2020/09/05 06:00 PHST- 2020/06/30 00:00 [received] PHST- 2020/08/06 00:00 [accepted] PHST- 2020/09/05 06:00 [entrez] PHST- 2020/09/05 06:00 [pubmed] PHST- 2020/09/05 06:01 [medline] PHST- 2020/10/25 00:00 [pmc-release] AID - 10.1186/s42155-020-00148-9 [pii] AID - 148 [pii] AID - 10.1186/s42155-020-00148-9 [doi] PST - epublish SO - CVIR Endovasc. 2020 Oct 25;3(1):54. doi: 10.1186/s42155-020-00148-9.