title: Outcomes of EVAR with the endurant stent-graft system in patients with infrarenal ruptured abdominal aortic aneurysms: Is hostile anatomy a challenging factor?
abstract: OBJECTIVE
  To compare outcomes of endovascular aneurysm repair (EVAR) using the Endurant-I stent-graft system between patients who have ruptured abdominal aortic aneurysms (rAAAs) with normal and hostile anatomy.
  
  
  METHODS
  Patients with rAAAs who underwent EVAR between January 2008 and March 2014 were included in the study. There were 21 (70%) men and 9 (30%) women with a mean age of 70 years. Multidetector computed tomography (CT) angiography findings of the rAAA were classified according to the "Classification based on CT findings," and imaging planning was performed according to the Society of Interventional Radiology Guideline. Primary outcome measures (POM) were procedure-related mortality, 30-day mortality, and survival rate at 1 year. Secondary outcome measures (SOM) were technical success, open surgical conversion, complications, survival, relationship between size-severity of the rAAA and mortality, procedure time, hospital stay.
  
  
  RESULTS
  The periprocedural-EVAR mortality rate was 33%. The overall mortality rate without prehospital phase deaths was 40.0%. Seventy three percent of the patients with rAAAs had hostile anatomy. There were no statistically significant differences between the groups in POMs and SOMs (except mean hospital stay). Mean hospital stay was shorter in the normal anatomy group. The mortality rate was higher in patients with hematoma in both sides of the aorta and free intraperitoneal hematoma.
  
  
  CONCLUSIONS
  EVAR of rAAAs with hostile anatomy is feasible and off-label use of Endurant-I endografts could be expanded.
authors.affiliation: Turkiye Yuksek Ihtisas Hospital, Department of Interventional Radiology, Sihhiye, 06100 Ankara, Turkey. Electronic address: fkucukay@hotmail.com.
authors.forename: Fahrettin
authors.initials: F
authors.lastname: Kucukay
authors.affiliation: Turkiye Yuksek Ihtisas Hospital, Department of Radiology, Sihhiye, 06100 Ankara, Turkey. Electronic address: adnankkaran@yahoo.com.
authors.forename: Adnan
authors.initials: A
authors.lastname: Karan
authors.affiliation: Turkiye Yuksek Ihtisas Hospital, Department of Cardiovascular Surgery, Sihhiye, 06100 Ankara, Turkey. Electronic address: erdalsimsek@yahoo.com.
authors.forename: Erdal
authors.initials: E
authors.lastname: Şimşek
authors.affiliation: Turkiye Yuksek Ihtisas Hospital, Department of Radiology, Sihhiye, 06100 Ankara, Turkey. Electronic address: mustafaozdemirrr@yahoo.com.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Özdemir
authors.affiliation: Turkiye Yuksek Ihtisas Hospital, Department of Radiology, Sihhiye, 06100 Ankara, Turkey. Electronic address: sarperokten@yahoo.com.
authors.forename: Sarper
authors.initials: S
authors.lastname: Okten
authors.affiliation: Turkiye Yuksek Ihtisas Hospital, Department of Cardiovascular Surgery, Sihhiye, 06100 Ankara, Turkey. Electronic address: atulus@yahoo.com.
authors.forename: Ahmet Tulga
authors.initials: AT
authors.lastname: Ulus
mesh_terms: D000368:Aged; D001012:Aorta, Abdominal / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000706:statistics & numerical data*; D057510:Endovascular Procedures / Q000295:instrumentation / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Abdominal aorta; EVAR; Endovascular procedures; Ruptured aneurysm