The Performance of the Endurant Endoprosthesis in an Infrarenal Aortic Aneurysm with a Wide or Conical-Shaped Infrarenal Neck Anatomy

TL;DR

This study evaluates how well the Endurant endoprosthesis works in aortic aneurysm patients with wide or conical-shaped aortic necks compared to normal necks.

Contribution

The study provides new insights into the performance of the Endurant endoprosthesis in challenging aortic neck anatomies.

Findings

Patients with wide necks had lower reintervention-free survival compared to those with normal necks.

Proximal fixation failure was more common in the wide-neck group.

The conical-neck group showed no significant difference in reintervention-free survival compared to the reference group.

Abstract

Background/Objectives: Wide and conical-shaped infrarenal necks are risk factors for neck-related complications after Endovascular Aorta Aneurysm Repair (EVAR). The aim of this study is to investigate the performance of the Endurant endoprosthesis in wide/conical-shaped aortic neck anatomies compared to its performance in a normal infrarenal neck (reference group). Methods: A single-center, retrospective observational cohort study was performed, including consecutive subjects with an infrarenal abdominal aortic aneurysm, treated electively with an Endurant endoprosthesis. The primary endpoint was the freedom from aneurysm-related reinterventions through 1 year. Secondary endpoints included proximal fixation failure, type IA endoleak, stent migration, aneurysm sac remodeling, aneurysm-related mortality, freedom from reinterventions throughout available follow-up, and rupture. Results: A total of 268 patients were included, with a mean age of 73.3 years, and 85.1% were male. Freedom from aneurysm-related reinterventions was significantly lower in the wide-neck group (60.0%) compared to the reference group (81.1%; p = 0.018) but not for the conical-neck group (70.3%; p = 0.286). Median time to first reintervention was 1.7 (IQR 0.8; 4.4 years) in the reference group, 2.9 years (IQR 0.3; 5.0 years) in the wide-neck group (p = 0.547) and 3.8 years (IQR 0.4; 6.5) in the conical-neck group (p = 0.123). The proximal fixation failure rate was 7.4% in the wide-neck group compared to 3.3% in the reference group (p = 0.155) and 1.7% in the conical-neck group (p = 0.525). The type IA endoleak rate was 4.9% in the wide-neck group versus 3.3% in the reference group (p = 0.250). Conclusions: In the group with wide necks, reintervention-free survival was lower compared to the reference group, which seems to be driven by proximal fixation failure.

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