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The Journal of Cardiovascular Surgery 2021 Feb 26

DOI: 10.23736/S0021-9509.21.11643-X

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Up to 10-years follow-up after EVAR with the Endurant stent graft system: a single-center experience

Pieter B. SALEMANS 1 , Robert C. LIND 2, Rens A. van der LINDE 1, Maurice P. PIERIE 1, Wilbert M. FRITSCHY 1

1 Department of Vascular Surgery Isala, Zwolle, The Netherlands; 2 Department of Thoracic and Vascular Surgery, Linköping University Hospital, Linköping, Sweden


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BACKGROUND: Endovascular aneurysm repair (EVAR) has become the preferred treatment for infrarenal abdominal aortic aneurysms (AAA) over open surgical repair. The Endurant stent graft is widely used and large registries report low rates of aneurysm-related mortality and reinterventions at midterm follow-up. Reports of long-term follow-up are limited. The aim of this study is to report our experiences and share our results, reintervention rate and mortality at long-term follow-up after using the Endurant stent graft.
METHODS: All consecutive patients treated between 2009 and 2013 with the Medtronic Endurant I and II stent graft for an infrarenal AAA in an elective setting were included. Primary outcomes were overall and aneurysm-related survival and reintervention rates.
RESULTS: 165 consecutive patients (median age 74; IQR 68-79) with an aneurysm diameter of 62mm (IQR 58-70) and neck length of 29mm (IQR 21-40) were electively treated with the Endurant I or II stent graft. 134 patients (81.2%) were treated inside IFU (instructions for use) and 31 (18.8%) outside IFU. At median follow-up of 76 months (IQR 50-97), 60 patients (36.4%) were deceased. Kaplan-Meier estimates at 10 years follow-up of overall survival and freedom from aneurysm-related mortality were respectively 48.5% (CI 43.7-53.3%) and 97.3% (CI 95.7-98.9%). Freedom from reintervention was 86.0% with a 83.1-88.9% CI at 5 years follow-up and 75.6% with a 70.2-81.0% CI at 10 years follow-up. A total of 25 (15.2%) patients had an EVAR-related reintervention; indications were endoleak (EL) type 1A (n=11), EL type 1B (n=3), EL type 2 (n=6), EL type 3 (n=1) and limb occlusion (n=4). We found no significant differences in outcome between the inside and outside IFU groups. At 5 years follow-up 92.6% of patients had stable or decreased diameter, and 7.4% had an increased diameter.
CONCLUSIONS: This large cohort single-center study demonstrates the effectiveness and safety of the Endurant stent graft system at long-term follow-up with low reintervention rates and aneurysm-related mortality.


KEY WORDS: Aortic aneurysm, abdominal; Endovascular procedures; Vascular surgical procedures

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