title: Endovascular repair of ruptured abdominal aortic aneurysms with the endurant stent-graft: a combined experience from three centers.
abstract: Endovascular repair of ruptured abdominal aortic aneurysms (RAAAs) has been previously reported to reduce mortality rates compared to open repair. Newer stent-grafts may provide even better results with applicability in a larger number of patients. We present our experience with the Medtronic Endurant endograft over a three-year period.
  
  
  
  Consecutive cases of RAAAs which have been managed with the Endurant stent-graft were recruited from three centers and were analyzed retrospectively. Twenty-three patients (22 males; mean age 74±9 years) were treated between June 2010 and May 2013.
  
  
  
  The technical success rate was 100% with no intraoperative endoleaks. Thirty-day mortality was 13% (3/23 patients). Two patients required prolonged hospitalization and mechanical ventilation. For the remaining 18 patients, the average hospitalization length was 5.5 days. Two major risk factors were found to be significantly associated with increased mortality: low systolic blood pressure on arrival at the hospital (63±6 vs. 99±22; P=0.01), and post-operative development of an abdominal compartment syndrome (Relative Risk - RR=13.3, 95% confidence interval - CI: 1.6-106; P=0.03). Other important clinical variables which did not significantly affect mortality included age (mean age 83±9 years in those who died vs. 73±9 years in the survivors; P=0.09), type of graft (bifurcated vs. aorto-uni-iliac; RR=2.2, 95% CI: 0.3-15; P=0.4), aneurysm diameter (11±4 cm vs. 9±2 cm; P=0.28), and proximal neck angulation (68±14 vs. 57±26 degrees; P=0.5). A proximal neck angulation >75° was not associated with a higher mortality rate (RR=1.33, 95% CI: 0.22-7.8; P=1).
  
  
  
  Endovascular repair of RAAAs resulted in high technical success and low mortality rates in this series of patients treated with the Endurant stent graft. Hypotension on arrival to the hospital and development of an abdominal compartment syndrome were predictive of increased risk of death. Patient age, aneurysm diameter and graft configuration did not negatively impact survival. Non-compliance with the device instructions for use (IFU) did not adversely affect results in this small patient series. Larger studies are needed to confirm our results.
authors.affiliation: Department of Vascular Surgery, Hippokratio University Hospital, Thessaloniki, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Papazoglou
authors.affiliation: Department of Vascular Surgery, Hippokratio University Hospital, Thessaloniki, Greece - alexandrosmallios@gmail.com.|Department of Vascular Surgery, University of Oklahoma, Tulsa, OK, USA.|Department of Vascular Surgery, Mutualiste Montsouris Institute, Paris, France.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Mallios
authors.affiliation: Department of Vascular Surgery, Agia Olga Hospital, Athens, Greece.
authors.forename: Bryan
authors.initials: B
authors.lastname: Buster
authors.affiliation: Department of Vascular Surgery, Agia Olga Hospital, Athens, Greece.
authors.forename: Pavlos
authors.initials: P
authors.lastname: Antoniadis
authors.affiliation: Department of Vascular Surgery, Hippokratio University Hospital, Thessaloniki, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Karkos
authors.affiliation: Department of Vascular Surgery, Agia Olga Hospital, Athens, Greece.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Staramos
authors.affiliation: Department of Vascular Surgery, Agia Olga Hospital, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Dervisis
authors.affiliation: Department of Vascular Surgery, University of Oklahoma, Tulsa, OK, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Messiner
authors.affiliation: Department of Vascular Surgery, University of Oklahoma, Tulsa, OK, USA.
authors.forename: John
authors.initials: J
authors.lastname: Blebea
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001794:Blood Pressure; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D006115:Greece; D006801:Humans; D007022:Hypotension / Q000401:mortality / Q000503:physiopathology; D059325:Intra-Abdominal Hypertension / Q000401:mortality / Q000503:physiopathology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome