Superior mesenteric artery outcomes after large fenestration strut relocation with the Zenith Fenestrated endoprosthesis

Background The Zenith® 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