title: The Endurant Stent Graft System: 15-month follow-up report in patients with challenging abdominal aortic anatomies.
abstract: OBJECTIVE
  The objective of this study is to report a 15-month follow-up with the Endurant Stent Graft System in patients with challenging aortic anatomies.
  
  
  METHODS
  At three German clinics, a consecutive series of 50 patients underwent endovascular abdominal aortic repair (EVAR) for challenging abdominal aortic aneurysm with the Endurant stent graft between November 2008 and May 2009. EVAR was elective in 48 cases and emergent in two. Patients had short (≤15 mm) aortic necks, severe suprarenal/infrarenal angulation, and/or small (<8 mm), calcified, severely angulated, or tortuous iliac or femoral access vessels. Additionally, a cohort of 40 patients without challenging anatomies were retrospectively analysed to clarify differences concerning technical success, mortality, and morbidity between these groups.
  
  
  RESULTS
  The primary technical success rate was 92% (46/50). The 30-day mortality rate was 2% (1/50), the death due to multiorgan failure. Intraoperative angiograms revealed three type I endoleaks (2 proximal and 1 distal), and one of those was persisting at 30 days (30-day rate, 2%). Postoperative imaging discovered no further type I or type III endoleaks. The 30-day rate of the type II endoleak was 6% (3/50). There were two cases of graft limb occlusion, both requiring reintervention within 30 days. Follow-up was available in all of the 50 patients (100%) over a median of 15 months (1-25). During this time, seven patients died (overall mortality, 16%; 8/50), besides the above-described patient, all of them unrelated to the procedure. Compared to the 30-day results with the Endurant stent graft in non-challenging anatomies (no type I endoleak; no graft limb occlusion; all-cause mortality, 0%), procedure-related complications in challenging anatomies are increasing.
  
  
  CONCLUSIONS
  Early and 15-month results with the Endurant stent graft in patients with challenging aortic anatomies are encouraging.
authors: Department of Vascular and Endovascular Surgery, Ruprecht-Karls University, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany. alexander.duerr@med.uni-heidelberg.de
authors: Alexander
authors: A
authors: Hyhlik-Dürr
authors: Tim F
authors: TF
authors: Weber
authors: Drossos
authors: D
authors: Kotelis
authors: Fabian
authors: F
authors: Rengier
authors: Johannes
authors: J
authors: Gahlen
authors: Stefanie
authors: S
authors: Böck
authors: Jürgen
authors: J
authors: Köhler
authors: Christoph-M
authors: CM
authors: Ratusinski
authors: Dittmar
authors: D
authors: Böckler
references: J Endovasc Surg. 1997 May;4(2):203-25
references: 9185008
references: J Vasc Surg. 2008 Apr;47(4):702-6; discussion 707
references: 18296015
references: J Cardiovasc Surg (Torino). 2008 Aug;49(4):429-47
references: 18665106
references: Eur J Vasc Endovasc Surg. 2008 Dec;36(6):653-60
references: 18774313
references: Lancet. 2004 Sep 4-10;364(9437):843-8
references: 15351191
references: Semin Vasc Surg. 2008 Mar;21(1):25-30
references: 18342732
references: J Vasc Surg. 2004 Jan;39(1):10-9
references: 14718804
references: J Vasc Surg. 2002 May;35(5):1048-60
references: 12021727
references: J Endovasc Ther. 2009 Apr;16(2):125-35
references: 19456203
references: J Endovasc Surg. 1997 May;4(2):152-68
references: 9185003
references: J Vasc Interv Radiol. 2010 Jan;21(1):73-80
references: 20123193
references: Ann Vasc Surg. 2004 Nov;18(6):621-8
references: 15599617
references: Eur J Vasc Endovasc Surg. 2009 Aug;38(2):155-61
references: 19523863
references: J Vasc Surg. 2004 Jan;39(1):34-43
references: 14718809
references: J Vasc Surg. 2009 Oct;50(4):738-48
references: 19595545
references: N Engl J Med. 2005 Jun 9;352(23):2398-405
references: 15944424
references: Ann N Y Acad Sci. 2006 Nov;1085:1-10
references: 17182917
references: Eur J Vasc Endovasc Surg. 2004 May;27(5):477-83
references: 15079769
references: Lancet. 2005 Jun 25-Jul 1;365(9478):2179-86
references: 15978925
references: J Cardiovasc Surg (Torino). 2009 Apr;50(2):159-64
references: 19329912
references: Eur J Vasc Endovasc Surg. 2007 Dec;34(6):693-8
references: 17669669
references: J Vasc Surg. 2001 Feb;33(2):296-302; discussion 302-3
references: 11174781
references: N Engl J Med. 2004 Oct 14;351(16):1607-18
references: 15483279
references: J Thorac Cardiovasc Surg. 2006 Aug;132(2):361-8
references: 16872963
references: J Cardiovasc Surg (Torino). 2009 Apr;50(2):153-8
references: 19329911
references: J Endovasc Ther. 2010 Jun;17(3):439-48
references: 20557189
references: Ann Vasc Surg. 1991 Nov;5(6):491-9
references: 1837729
references: J Endovasc Surg. 1997 Feb;4(1):39-44
references: 9034918
references: J Endovasc Ther. 2004 Feb;11(1):41-8
references: 14748630
references: J Vasc Surg. 2002 Oct;36(4):679-84
references: 12368725
references: Radiologe. 2007 Nov;47(11):1003-11
references: 17943264
references: Lancet. 2005 Jun 25-Jul 1;365(9478):2187-92
references: 15978926
references: J Cardiovasc Surg (Torino). 2010 Aug;51(4):481-91
references: 20671632
references: J Vasc Surg. 2008 Sep;48(3):535-45
references: 18635335