title: Use of Endurant Stent-Graft Aortic Extensions for the Treatment of Focal Aortic Pathology.
abstract: BACKGROUND
  To describe our experience with the endovascular treatment of focal abdominal aortic pathology with an adequate distal neck length using Endurant (Medtronic) aortic extension cuffs.
  
  
  METHODS
  From July 2010 to May 2015, 16 patients (14 male), with a mean age of 73.6 years (range, 59-88), were treated for focal abdominal aortic pathology using only Endurant (Medtronic) aortic cuff extensions. The indication for intervention was a saccular abdominal aortic aneurysm (AAA) in 5 patients, a fusiform aortic aneurysm in 6 patients, abdominal aortic dissection in 2 patients, an aortic juxtarenal rupture in 1 patient, a large anastomotic pseudoaneurysm of previous bifurcated open repair in 1 patient, and a juxtarenal aneurysm above a previous open AAA repair. Aortic lesions had a mean diameter of 52.9 (range, 32-90) mm. All patients were operated under local anesthesia with unilateral femoral exposure. A single 70-mm long Endurant aortic extension was deployed in 5 cases, while in the remaining 11 cases, 2 cuffs were used with the "telescopic" (double tube) technique. A chimney technique was performed in 5 cases (with a bare metal stent in the renal artery in 3 and a stent graft in the celiac artery in 2).
  
  
  RESULTS
  The intraoperative technical success was 100% with no endoleaks on completion angiogram. There was no 30-day mortality. One patient developed acute limb ischemia immediately postoperatively and was treated successfully with thrombectomy. During a mean follow-up of 21.9 months, 1 patient died 2 months after the procedure due to cardiac arrest unrelated to his aortic operation. There was 1 early type IIb endoleak (present at the 30-day follow-up computerized tomography scan), which disappeared 10 months after the procedure. Finally, 1 patient was diagnosed with a type II endoleak and stable diameter 53 months postoperatively, while to date there are no cases of stent-graft migration.
  
  
  CONCLUSIONS
  The use of Endurant aortic extensions in aneurysms with adequate distal neck is a safe, simple, customizable, and cost-effective method which presents similar early results with standard endovascular aneurysm repair technique.
authors.affiliation: 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece. Electronic address: kimisnet@gmail.com.
authors.forename: Ioakeim T
authors.initials: IT
authors.lastname: Giagtzidis
authors.affiliation: 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Konstantinidis
authors.affiliation: 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Kalogirou
authors.affiliation: 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Christos D
authors.initials: CD
authors.lastname: Karkos
authors.affiliation: 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Konstantinos O
authors.initials: KO
authors.lastname: Papazoglou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000601:surgery; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000601:surgery; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D000072226:Computed Tomography Angiography; D057867:Endoleak / Q000209:etiology; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome