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Endovascular Repair of Ruptured Abdominal Aortic Aneurysms with the Endurant Stent-Graft
Konstantinos Papazoglou, MD1, Alexandros Mallios2, Pavlos Antoniadis, MD3, Christos Karkos, MD1, Dimitris Staramos, MD3, Konstantinos Dervisis, MD3, John Blebea, MD, MBA2.
1Hippokratio University Hospital, Thessaloniki, Greece, 2University of Oklahoma, Tulsa, OK, USA, 3Agia Olga Hospital, Athens, Greece.
OBJECTIVES:
Endovascular repair of ruptured abdominal aortic aneurysms has previously been reported to reduce mortality rates. Newer stent grafts may provide even better results with applicability in a larger number of patients. We present our outcomes with the Endurant endograft during a three-year period.
METHODS:
Consecutive cases of ruptured abdominal aortic aneurysms were retrospectively analysed. Twenty patients (19 male; mean age 75 ± 9 years) were treated with the Medtronic Endurant abdominal stent graft between the years 2010 and 2013.
RESULTS:
The technical success rate was 100% with no intra-operative endoleaks. Thirty-day mortality was 15% (3/20 patients). Two patients required prolonged hospitalization and mechanical ventilation. For the remaining 15 patients the average hospitalization length was 6 days. Two major risk factors were found to be associated with increased mortality. These included a low systolic blood pressure on arrival at the hospital (63 ± 6 vs 96 ± 20 mmHg; p=0.01) and the post-operative development of an abdominal compartment syndrome (OR= 58, 95% CI: 2-1863; p=0.02). Other important clinical variables which did not significantly affect mortality included age (83 ± 9 vs 73 ± 9, of those who died and survived, respectively; p=0.10), type of graft (bifurcated vs aorto-uni-iliac; OR=2.3, 95% CI: 0.2-35; p=0.50), aneurysm diameter (10.5 ± 3.5 vs 9.4 ± 1.9 cm; p=0.41), and proximal neck angulation (68 ± 14o vs 65 ± 20o; p=0.78). Even exceeding 75o of proximal neck angulation was not associated with a higher mortality rate (OR=1.2, 95% CI: 0.08-16.4; p=0.8)
CONCLUSIONS:
Endograft repair of ruptured abdominal aortic aneurysms 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 affect survival. Success in patients with severe aortic neck angulation, exceeding manufacturer’s instruction for use, suggest that supra-renal fixation and newer stent design of the Endurant graft may provide better results in this challenging group of patients.
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