Comparison of Cook Zenith and Relay plus Physician-Modified Endografts for Complex Abdominal and Thoracoabdominal...

Complex abdominal aortic aneurysms (CAAAs) or thoracoabdominal aneurysms (TAAs) often require urgent repair, but custom-made devices are unavailable in such settings. Physician-modified endografts (PMEGs) allow for rapid, patient-specific fenestrated or branched endografts. This study assessed clinical outcomes of CAAA and TAA PMEGs performed at a single Swedish center and compared results using the Cook Zenith and Relay Plus platforms.

A retrospective single-center review was conducted on all CAAA and TAA PMEG procedures at Linköping University Hospital between January 2012 and December 2023. Data were collected retrospectively. Primary outcomes included mortality and technical success; secondary outcomes were major adverse events (MAEs) within 30 days, reinterventions, and bridging stent-graft patency.

All patients were treated using either the Zenith or Relay Plus systems. 42 patients were included (20 Zenith, 22 Relay Plus). Relay Plus was used more frequently in TAA (0% vs. 36%, P = 0.004). Median follow-up duration was 4.8 years (1.8-8.2 years). Technical success was 90% in both groups. Four-year all-cause survival was 64% in both subgroups (P = 0.49). MAEs within 30 days occurred in 12% (n = 5) without significant subgroup differences. Freedom from reintervention was 69% in the Zenith group and 59% in the Relay Plus group at 4 years (P = 0.34). Bridging stent-graft primary, primary assisted and secondary patencies were 91%, 97%, and 98%, respectively at 4 years.

PMEGs using both platforms offer favorable outcomes in mortality, technical success, MAEs, and target vessel patency. Despite Relay Plus being used in more complex anatomies, no significant outcome differences were observed. This study supports the use of both Zenith and Relay Plus in the construction of PMEGs.