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Abstract
Objective: This study aimed to compare perioperative and postoperative outcomes after endovascular repair of abdominal aortic aneurysms (AAAs) in patients with various neck morphologic features. Methods: Data from the Endurant Stent Graft Natural Selection Global Postmarket Registry (ENGAGE) were used for the analyses. Patients were categorized into three different groups according to proximal aortic neck anatomy: regular (REG), intermediate (INT), and challenging (CHA). REG was defined as AAAs with a proximal neck >= 15 mm combined with a suprarenal angulation (alpha) <= 45 degrees and an infrarenal neck angulation (beta) <= 60 degrees. INT was defined as AAAs with a proximal neck of 10 to 15 mm combined with alpha <= 45 degrees and beta <= 60 degrees or with a proximal neck of >15 mm combined with alpha <= 60 degrees and beta = 60 to 75 degrees or alpha = 45 to 60 degrees and beta <= 75 degrees. CHA was defined as infrarenal necks that exceed at least one of the three defining factors. Results: Overall, 925 patients (75.9%) had REG anatomy, 189 patients (15.5%) had INT anatomy, and 104 patients (8.5%) had CHA anatomy. Patient demographics and risk factors were similar. There was a significant difference in AAA diameter between the REG and CHA groups (59.4 mm vs 65.2 mm; P < .001). Technical success was similar among groups (REG 99.1% vs INT 99.5% vs CHA 97.1%). There were no differences in mortality or the need for secondary procedures within 30 days or at 1 year. A significantly higher rate of type I endoleaks within 30 days was seen in CHA compared with REG (adjusted odds ratio, 0.15; 95% confidence interval, 0.05-0.46) and INT (adjusted odds ratio, 0.08; 95% confidence interval, 0.01-0.70), but there was no difference at 1-year follow-up. Conclusions: This real-world, global experience shows promising results and indicates that endovascular AAA repair with the Endurant stent graft (Medtronic Vascular, Santa Rosa, Calif) is safe and effective in patients with challenging aortic neck anatomy. However, long-term follow-up of patients is required to confirm results.
Keywords
ENDOVASCULAR AAA REPAIR, AORTIC-ANEURYSM REPAIR, NECK ANGULATION, COMPLICATIONS, SYSTEM, WOMEN

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Please use this url to cite or link to this publication:

MLA
Broos, Pieter PHL, et al. “Performance of the Endurant Stent Graft in Challenging Anatomy.” JOURNAL OF VASCULAR SURGERY, vol. 62, no. 2, 2015, pp. 312–18.
APA
Broos, P. P., Stokmans, R. A., van Sterkenburg, S. M., Torsello, G., Vermassen, F., Cuypers, P. W., … Teijink, J. A. (2015). Performance of the Endurant stent graft in challenging anatomy. JOURNAL OF VASCULAR SURGERY, 62(2), 312–318.
Chicago author-date
Broos, Pieter PHL, Rutger A Stokmans, Steven MM van Sterkenburg, Giovanni Torsello, Frank Vermassen, Philippe WM Cuypers, Marc RHM van Sambeek, and Joep AW Teijink. 2015. “Performance of the Endurant Stent Graft in Challenging Anatomy.” JOURNAL OF VASCULAR SURGERY 62 (2): 312–18.
Chicago author-date (all authors)
Broos, Pieter PHL, Rutger A Stokmans, Steven MM van Sterkenburg, Giovanni Torsello, Frank Vermassen, Philippe WM Cuypers, Marc RHM van Sambeek, and Joep AW Teijink. 2015. “Performance of the Endurant Stent Graft in Challenging Anatomy.” JOURNAL OF VASCULAR SURGERY 62 (2): 312–318.
Vancouver
1.
Broos PP, Stokmans RA, van Sterkenburg SM, Torsello G, Vermassen F, Cuypers PW, et al. Performance of the Endurant stent graft in challenging anatomy. JOURNAL OF VASCULAR SURGERY. 2015;62(2):312–8.
IEEE
[1]
P. P. Broos et al., “Performance of the Endurant stent graft in challenging anatomy,” JOURNAL OF VASCULAR SURGERY, vol. 62, no. 2, pp. 312–318, 2015.
@article{6875287,
  abstract     = {Objective: This study aimed to compare perioperative and postoperative outcomes after endovascular repair of abdominal aortic aneurysms (AAAs) in patients with various neck morphologic features. 
Methods: Data from the Endurant Stent Graft Natural Selection Global Postmarket Registry (ENGAGE) were used for the analyses. Patients were categorized into three different groups according to proximal aortic neck anatomy: regular (REG), intermediate (INT), and challenging (CHA). REG was defined as AAAs with a proximal neck >= 15 mm combined with a suprarenal angulation (alpha) <= 45 degrees and an infrarenal neck angulation (beta) <= 60 degrees. INT was defined as AAAs with a proximal neck of 10 to 15 mm combined with alpha <= 45 degrees and beta <= 60 degrees or with a proximal neck of >15 mm combined with alpha <= 60 degrees and beta = 60 to 75 degrees or alpha = 45 to 60 degrees and beta <= 75 degrees. CHA was defined as infrarenal necks that exceed at least one of the three defining factors. 
Results: Overall, 925 patients (75.9%) had REG anatomy, 189 patients (15.5%) had INT anatomy, and 104 patients (8.5%) had CHA anatomy. Patient demographics and risk factors were similar. There was a significant difference in AAA diameter between the REG and CHA groups (59.4 mm vs 65.2 mm; P < .001). Technical success was similar among groups (REG 99.1% vs INT 99.5% vs CHA 97.1%). There were no differences in mortality or the need for secondary procedures within 30 days or at 1 year. A significantly higher rate of type I endoleaks within 30 days was seen in CHA compared with REG (adjusted odds ratio, 0.15; 95% confidence interval, 0.05-0.46) and INT (adjusted odds ratio, 0.08; 95% confidence interval, 0.01-0.70), but there was no difference at 1-year follow-up. 
Conclusions: This real-world, global experience shows promising results and indicates that endovascular AAA repair with the Endurant stent graft (Medtronic Vascular, Santa Rosa, Calif) is safe and effective in patients with challenging aortic neck anatomy. However, long-term follow-up of patients is required to confirm results.},
  author       = {Broos, Pieter PHL and Stokmans, Rutger A and van Sterkenburg, Steven MM and Torsello, Giovanni and Vermassen, Frank and Cuypers, Philippe WM and van Sambeek, Marc RHM and Teijink, Joep AW},
  issn         = {0741-5214},
  journal      = {JOURNAL OF VASCULAR SURGERY},
  keywords     = {ENDOVASCULAR AAA REPAIR,AORTIC-ANEURYSM REPAIR,NECK ANGULATION,COMPLICATIONS,SYSTEM,WOMEN},
  language     = {eng},
  number       = {2},
  pages        = {312--318},
  title        = {Performance of the Endurant stent graft in challenging anatomy},
  url          = {http://dx.doi.org/10.1016/j.jvs.2015.03.024},
  volume       = {62},
  year         = {2015},
}

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