title: Standard endovascular treatment of abdominal aortic aneurysms in patients with very short proximal necks using the Endurant stent graft.
abstract: OBJECTIVE
  This study evaluated and compared the midterm results of endovascular aortic aneurysm repair with the Endurant (Medtronic Inc, Santa Rosa, Calif) stent graft system in off-label use in patients with short (<10 mm) proximal aortic necks and in patients treated according to device-specific instructions for use.
  
  
  METHODS
  This was a case-control (2:1) single-center retrospective analysis of prospectively collected data performed between September 2008 and December 2012. Analysis identified 19 elective patients with short (<10 mm) proximal necks and mild angulations (≤45°) treated with the Endurant stent graft and 38 patients matched for age, sex, and aneurysm diameter with proximal aortic necks ≥10 mm in length who met the instructions for use. End points included technical and clinical success and freedom from any secondary intervention, any type of endoleak, and aneurysm-related death.
  
  
  RESULTS
  The short-neck group was a mean ± standard deviation age of 71.7 ± 8.9 years, 84% were men, and their mean infrarenal aortic neck length was 6.1 ± 1.2 mm. Mean suprarenal and infrarenal angles were 110° ± 10.4° and 170° ± 15.4°, respectively. Aortic neck diameters were similar between the groups (26.6 ± 3.8 vs 25.7 ± 3.7 mm; P = .36). Primary technical success was achieved in all cases. Off-label patients were more likely to require additional proximal cuff deployment to successfully obtain a seal (21% vs 3%; P = .04). The two patient groups were similar in rates of perioperative mortality, morbidity, and complications. Mean follow-up of 24 ± 12 months revealed no differences in clinical success, freedom from reintervention, and aneurysm-related death. No type I endoleaks were observed in either group during the follow-up period.
  
  
  CONCLUSIONS
  The Endurant stent graft system applied off-label in patients with very short aneurysm necks (<10 mm) with mild angulation showed acceptable treatment results. These midterm results might suggest its use in carefully selected patients with very short neck anatomy. Long-term data are needed to verify the observed durability of the Endurant stent graft.
authors.affiliation: Department of Surgery-Vascular Surgery Unit, Medical School, University of Ioannina, Ioannina, Greece. Electronic address: mimats@cc.uoi.gr.
authors.forename: Miltiadis
authors.initials: M
authors.lastname: Matsagkas
authors.affiliation: Department of Surgery-Vascular Surgery Unit, Medical School, University of Ioannina, Ioannina, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Kouvelos
authors.affiliation: Department of Surgery-Vascular Surgery Unit, Medical School, University of Ioannina, Ioannina, Greece.
authors.forename: Michalis
authors.initials: M
authors.lastname: Peroulis
authors.affiliation: Department of Surgery-Vascular Surgery Unit, Medical School, University of Ioannina, Ioannina, Greece.
authors.forename: Stavros
authors.initials: S
authors.lastname: Avgos
authors.affiliation: Department of Anesthesiology, Medical School, University of Ioannina, Ioannina, Greece.
authors.forename: Eleni
authors.initials: E
authors.lastname: Arnaoutoglou
authors.affiliation: Department of Surgery-Vascular Surgery Unit, Medical School, University of Ioannina, Ioannina, Greece.
authors.forename: Nektario
authors.initials: N
authors.lastname: Papa
authors.affiliation: Department of Anesthesiology, Medical School, University of Ioannina, Ioannina, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Papadopoulos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D018795:Device Approval; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D006115:Greece; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D011356:Product Labeling; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome