Cook Zenith

The Cook Zenith AAA endovascular graft was approved for use by the FDA in May 2003 (FDA 2013). It contains three different components the main graft module, the contralateral limb module, and the ipsilateral iliac extension (Fig. 21.12). All of these are constructed with a full-thickness woven polyester fabric attached to self-expanding stainless steel Cook-Z stents with braided polyester and monofilament polypropylene sutures. The distal end of the main body has a bare stainless steel stent designed to allow suprarenal fixation without disrupting blood flow through the renal arteries (Fig. 21.13). The stent also has hooks on each strut spaced 3 mm apart that are intended to dig into the aortic wall and prevent migration (Fig. 21.13). The proximal covered stent, located just below the bare suprarenal stent. 

The Cook Zenith Flex stent graft with all components assembled. 

Currently there is only one prefenestrated endovascular stent-graft system approved by the FDA for use in the United States. It is an iteration of the Cook Zenith called the Cook Zenith Fenestrated . It is custom-made for each patient based on their personal aortic anatomy. This requires detailed CT scans of the abdominal aorta to properly locate the renal arteries and the superior mesenteric artery. The device is then manufactured with holes in the top piece for the renal arteries and a scallop at the top for the superior mesenteric artery (Fig. 21.19). These fenestrations are usually supported by a nitinol metal ring sewn around the circumference of the fenestration, as seen in the image taken from the study by Halak et al. (2006) (Fig. 21.20). 

Cook Zenith fenestrated stent-graft installed with the two fenestrations to the renal arteries and one scallop for the superior mesenteric artery. 

Australian, British and American surgeons have looked at the intermediate results of the US trial for the fenestrated graft to evaluate the safety and shortterm effectiveness of the device.Thirty patients with short proximal necks were enrolled in the trial and treated with the Cook Zenith custom-fenestrated devices. None of the visceral arteries, renal or superior mesenteric, were lost as a result of the surgery. After 24 months there were no aneurysm-related deaths, ruptures, or conversions to open surgeries. There were 6 incidences of type II endoleak at 12 months and 4 at 24 months. In all patients the diameter... 

Correa, M. P. and Oderich, G. S. (2012). Percutaneous endovascular repair of juxta-renal aortic aneurysm using customized Cook Zenith fenestrated stent graft. J Vase Surg, 56(6), 1827. doi 10.1016/j.jvs.2012.10.049. 

Mertens, J., Houthoofd, S., Daenens, K., Fourneau, I., Maleux, G., Lerut, P. and Nevelsteen, A. (2011). Long-term results after endovascular abdominal aortic aneurysm repair using the Cook Zenith endograft. / Fuse Surg, 54(l),48-57.e2. doi 10.10l6/j.jvs.2010.12.068. 

Anaconda device, 662-3 AneuRx device, 651-3 Aorfix device, 661 commercial stent-graft devices for AAA and TAA repair, 649-50 Cook Zenith Flex stent graft, 658 Endurant II and Valiant devices, 653-6... 

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