AAA with a Challenging Neck: Early Outcomes Using the Endurant Stent-Graft System

作者：Setacci F; Sirignano P; de Donato G; Chisci E; Iacoponi F; Galzerano G; Palasciano G; Cappelli A; Setacci C^*

来源：European Journal of Vascular and Endovascular Surgery, 2012, 44(3): 274-279.

DOI：10.1016/j.ejvs.2012.04.031

• EVAR
• Endurant stent-graft
• Proximal aortic neck
• Complications

Objectives: The efficacy and safety of endovascular aneurysm repair is disputable in aneurysms with a short, angulated, wide, conical, or thrombus-lined neck making a reliable seal difficult to achieve. The influence of a challenging neck on early results using the Endurant stent-graft system in high risk patients was investigated. %26lt;br%26gt;Materials and methods: A retrospective study conducted on a prospectively compiled database of 72 elective patients with challenging neck treated with the Endurant system (Endurant Stent Graft, Medtronic AVE, Santa Rosa, CA, USA). These patients were compared to a control group (n = 65) without significant neck problems. Endpoints were early technical and clinical success, deployment accuracy and differences in operative details at one month follow-up. Data are reported as mean and standard deviation or as absolute frequency and percentage (%). Normality distribution and homogeneity of variances were tested by Shapiro-Wilks and Levene tests, respectively. Inter-group comparisons for each variable were made by t-test or chi 2-test or Fisher exact test. A p %26lt; 0.05 was considered statistically significant. %26lt;br%26gt;Results: Mean age was 76.12 years; 76.6% were males. Risk factors and pre-operative variables did not differ significantly between the two groups. Mean neck length was 10.56 mm in patients with challenging anatomies and 22.85 mm in controls. Patients with a challenging neck differed significantly (p %26lt; 0.001) from controls in terms of mean infrarenal (37.67 degrees vs. 20.12 degrees) and suprarenal angle (19.63 degrees vs. 15.57 degrees); 82% of patients with a challenging neck were ASA III/IV (vs. 86%). Technical success was 100%, with four unplanned proximal extension in challenging group. No type I endoleaks or aneurysm-related deaths occurred in either group; major complications were 1.54% vs. 1.39% (p = 0.942). Operative details were similar in both groups. %26lt;br%26gt;Conclusion: Treatment with the Endurant stent-graft is technically feasible and safe, yielding satisfactory results even in challenging anatomies. Medium- and long-term data are needed to verify durability, but early results are promising.

• 出版日期2012-9