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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 2015 May 21


language: English

Endovascular repair of ruptured abdominal aortic aneurysms with the ENDURANT stent graft: a combined experience from three centers

Papazoglou K. 1, Mallios A. 1, 3, 4, Buster B. 3, Antoniadis P 2, Karkos C. 1, Staramos D. 2, Dervisis K. 2, Messiner R. 3, Blebea J. 3

1 Department of Vascular Surgery, Hippokratio University Hospital, Thessaloniki, Greece; 2 Department of Vascular Surgery, Agia Olga Hospital, Athens, Greece; 3 Department of Vascular Surgery, University of Oklahoma, Tulsa, OK, USA; 4 Department of Vascular Surgery, Institut Mutualiste Montsouris, Paris - France


BACKGROUND: 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.
METHODS: 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.
RESULTS: The technical success rate was 100% with no intra-operative 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 postoperative 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 ± 4cm vs 9 ± 2 cm; p=0.28), and proximal neck angulation (68 ± 14 vs 57 ± 26 degrees; p=0.5). A proximal neck angulation >75o was not associated with a higher mortality rate (RR=1.33, 95% CI: 0.22-7.8; p=1).
CONCLUSIONS: 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.

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