title: Outcomes of Endurant stent graft in narrow aortic bifurcation.
abstract: The purpose of this study was to compare the outcomes obtained with Endurant stent graft in the early and midterm period in the treatment of patients with narrow aortic bifurcation vs patients with standard aortic bifurcation.
  
  
  
  Data were prospectively collected from 817 patients with abdominal aortic aneurysm treated between November 2007 and August 2014 with the Endurant stent graft at our center. There were 87 patients (10.6%) with a narrow aortic bifurcation (≤20 mm; NA group). The remaining 730 patients (89.4%) had a standard aortic bifurcation (SA group). Early and estimated 3-year outcomes were evaluated in these patients in terms of survival, freedom from any device-related reinterventions, and freedom from graft thrombosis. Univariate and multivariate analyses in the NA group were performed to detect possible predictors for poor outcomes.
  
  
  
  The two groups were similar in terms of demographics, preoperative diagnostic assessment, and intraoperative data. In 211 of 817 patients (25.8%), an adjunctive iliac limb stenting by balloon-expanding stents was performed. Overall, 41 patients in the NA group (47.1%) underwent iliac limb stenting, whereas an iliac stent was implanted in just 170 patients (23.3%) in the SA group (P < .001). The mean follow-up was 16.3 months (range, 1-73 months). The estimated 3-year survival rate was similar between the two groups (87.2% in the NA group vs 80.8% in the SA group; P = .84). Furthermore, the estimated freedom from any device-related reinterventions was 92.9% in the NA group and 85.5% in the SA group (P = .1). Finally, the estimated 3-year freedom from graft thrombosis was 96.9% in the NA group and 94.8% in the SA group (P = .79). In the NA group at univariate and multivariate analyses, none of the examined preoperative or intraoperative factors were independent predictors of poor outcomes.
  
  
  
  Use of bifurcated Endurant stent graft, combined in almost half of the patients with narrow aortic bifurcation with additional aortoiliac stent placement, is feasible and safe. Early and midterm outcomes are similar to those obtained in non-narrow aortic bifurcation.
authors.affiliation: Department of Surgery, Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy. Electronic address: troisimd@gmail.com.
authors.forename: Nicola
authors.initials: N
authors.lastname: Troisi
authors.affiliation: Department of Vascular Surgery, St. Franziskus Hospital, Münster, Germany; Center for Vascular and Endovascular Surgery, University Hospital, Münster, Germany.
authors.forename: Konstantinos P
authors.initials: KP
authors.lastname: Donas
authors.affiliation: Department of Vascular Surgery, St. Franziskus Hospital, Münster, Germany; Center for Vascular and Endovascular Surgery, University Hospital, Münster, Germany.
authors.forename: Kristin
authors.initials: K
authors.lastname: Weiss
authors.affiliation: Department of Surgery, Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Michelagnoli
authors.affiliation: Department of Vascular Surgery, St. Franziskus Hospital, Münster, Germany; Center for Vascular and Endovascular Surgery, University Hospital, Münster, Germany.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Torsello
authors.affiliation: Department of Vascular Surgery, St. Franziskus Hospital, Münster, Germany; Center for Vascular and Endovascular Surgery, University Hospital, Münster, Germany.
authors.forename: Theodosios
authors.initials: T
authors.lastname: Bisdas
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000628:therapy; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013927:Thrombosis / Q000209:etiology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome