The Cook Zenith AAA Endovascular Graft

Abstract

From its inception in 1993, the Cook Zenith endovascular abdominal aortic aneurysm (AAA) graft presented a more complex but very controlled deployment mechanism. It has undergone several modifications since its first implantation and now can accommodate aortic neck diameters up to 32 mm and iliac artery diameters up to 20 mm. In addition, it possesses an uncovered, barbed suprarenal stent to allow for transrenal fixation of the device and has been loaded into low-profile, flexible, hydrophilic sheaths, which facilitate device delivery. The major advantages of the Zenith endograft include suprarenal fixation, a flexible delivery system, and the ability to treat a broad range of aortic and iliac artery diameters. This review will discuss the evolution of the Cook Zenith abdominal aortic aneurysm endovascular graft and will focus on the history and development of the device, device description and characteristics, and a thorough literature review focusing on the US Pivotal Study 4-year results, device-specific outcomes, factors associated with poor results, transrenal fixation and renal function, endoleaks, migration, aneurysm sac shrinkage, secondary procedures, and device cost.