Tags

Type your tag names separated by a space and hit enter

Endovascular repair of ruptured abdominal aortic aneurysms with the endurant stent-graft: a combined experience from three centers.
J Cardiovasc Surg (Torino). 2017 10; 58(5):643-649.JC

Abstract

BACKGROUND

Endovascular repair of ruptured abdominal aortic aneurysms (RAAAs) has been previously reported to reduce mortality rates compared to open repair. Newer stent-grafts may provide even better results with applicability in a larger number of patients. We present our experience with the Medtronic Endurant endograft over a three-year period.

METHODS

Consecutive cases of RAAAs which have been managed with the Endurant stent-graft were recruited from three centers and were analyzed retrospectively. Twenty-three patients (22 males; mean age 74±9 years) were treated between June 2010 and May 2013.

RESULTS

The technical success rate was 100% with no intraoperative endoleaks. Thirty-day mortality was 13% (3/23 patients). Two patients required prolonged hospitalization and mechanical ventilation. For the remaining 18 patients, the average hospitalization length was 5.5 days. Two major risk factors were found to be significantly associated with increased mortality: low systolic blood pressure on arrival at the hospital (63±6 vs. 99±22; P=0.01), and post-operative development of an abdominal compartment syndrome (Relative Risk - RR=13.3, 95% confidence interval - CI: 1.6-106; P=0.03). Other important clinical variables which did not significantly affect mortality included age (mean age 83±9 years in those who died vs. 73±9 years in the survivors; P=0.09), type of graft (bifurcated vs. aorto-uni-iliac; RR=2.2, 95% CI: 0.3-15; P=0.4), aneurysm diameter (11±4 cm vs. 9±2 cm; P=0.28), and proximal neck angulation (68±14 vs. 57±26 degrees; P=0.5). A proximal neck angulation >75° was not associated with a higher mortality rate (RR=1.33, 95% CI: 0.22-7.8; P=1).

CONCLUSIONS

Endovascular repair of RAAAs 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 impact survival. Non-compliance with the device instructions for use (IFU) did not adversely affect results in this small patient series. Larger studies are needed to confirm our results.

Authors+Show Affiliations

Department of Vascular Surgery, Hippokratio University Hospital, Thessaloniki, Greece.Department of Vascular Surgery, Hippokratio University Hospital, Thessaloniki, Greece - alexandrosmallios@gmail.com. Department of Vascular Surgery, University of Oklahoma, Tulsa, OK, USA. Department of Vascular Surgery, Mutualiste Montsouris Institute, Paris, France.Department of Vascular Surgery, Agia Olga Hospital, Athens, Greece.Department of Vascular Surgery, Agia Olga Hospital, Athens, Greece.Department of Vascular Surgery, Hippokratio University Hospital, Thessaloniki, Greece.Department of Vascular Surgery, Agia Olga Hospital, Athens, Greece.Department of Vascular Surgery, Agia Olga Hospital, Athens, Greece.Department of Vascular Surgery, University of Oklahoma, Tulsa, OK, USA.Department of Vascular Surgery, University of Oklahoma, Tulsa, OK, USA.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

25996842

Citation

Papazoglou, Konstantinos, et al. "Endovascular Repair of Ruptured Abdominal Aortic Aneurysms With the Endurant Stent-graft: a Combined Experience From Three Centers." The Journal of Cardiovascular Surgery, vol. 58, no. 5, 2017, pp. 643-649.
Papazoglou K, Mallios A, Buster B, et al. Endovascular repair of ruptured abdominal aortic aneurysms with the endurant stent-graft: a combined experience from three centers. J Cardiovasc Surg (Torino). 2017;58(5):643-649.
Papazoglou, K., Mallios, A., Buster, B., Antoniadis, P., Karkos, C., Staramos, D., Dervisis, K., Messiner, R., & Blebea, J. (2017). Endovascular repair of ruptured abdominal aortic aneurysms with the endurant stent-graft: a combined experience from three centers. The Journal of Cardiovascular Surgery, 58(5), 643-649. https://doi.org/10.23736/S0021-9509.16.08661-4
Papazoglou K, et al. Endovascular Repair of Ruptured Abdominal Aortic Aneurysms With the Endurant Stent-graft: a Combined Experience From Three Centers. J Cardiovasc Surg (Torino). 2017;58(5):643-649. PubMed PMID: 25996842.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endovascular repair of ruptured abdominal aortic aneurysms with the endurant stent-graft: a combined experience from three centers. AU - Papazoglou,Konstantinos, AU - Mallios,Alexandros, AU - Buster,Bryan, AU - Antoniadis,Pavlos, AU - Karkos,Christos, AU - Staramos,Dimitris, AU - Dervisis,Konstantinos, AU - Messiner,Ryan, AU - Blebea,John, Y1 - 2015/05/21/ PY - 2015/5/23/pubmed PY - 2017/7/18/medline PY - 2015/5/22/entrez SP - 643 EP - 649 JF - The Journal of cardiovascular surgery JO - J Cardiovasc Surg (Torino) VL - 58 IS - 5 N2 - BACKGROUND: Endovascular repair of ruptured abdominal aortic aneurysms (RAAAs) has been previously reported to reduce mortality rates compared to open repair. Newer stent-grafts may provide even better results with applicability in a larger number of patients. We present our experience with the Medtronic Endurant endograft over a three-year period. METHODS: Consecutive cases of RAAAs which have been managed with the Endurant stent-graft were recruited from three centers and were analyzed retrospectively. Twenty-three patients (22 males; mean age 74±9 years) were treated between June 2010 and May 2013. RESULTS: The technical success rate was 100% with no intraoperative endoleaks. Thirty-day mortality was 13% (3/23 patients). Two patients required prolonged hospitalization and mechanical ventilation. For the remaining 18 patients, the average hospitalization length was 5.5 days. Two major risk factors were found to be significantly associated with increased mortality: low systolic blood pressure on arrival at the hospital (63±6 vs. 99±22; P=0.01), and post-operative development of an abdominal compartment syndrome (Relative Risk - RR=13.3, 95% confidence interval - CI: 1.6-106; P=0.03). Other important clinical variables which did not significantly affect mortality included age (mean age 83±9 years in those who died vs. 73±9 years in the survivors; P=0.09), type of graft (bifurcated vs. aorto-uni-iliac; RR=2.2, 95% CI: 0.3-15; P=0.4), aneurysm diameter (11±4 cm vs. 9±2 cm; P=0.28), and proximal neck angulation (68±14 vs. 57±26 degrees; P=0.5). A proximal neck angulation >75° was not associated with a higher mortality rate (RR=1.33, 95% CI: 0.22-7.8; P=1). CONCLUSIONS: Endovascular repair of RAAAs 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 impact survival. Non-compliance with the device instructions for use (IFU) did not adversely affect results in this small patient series. Larger studies are needed to confirm our results. SN - 1827-191X UR - https://www.unboundmedicine.com/medline/citation/25996842/Endovascular_repair_of_ruptured_abdominal_aortic_aneurysms_with_the_endurant_stent_graft:_a_combined_experience_from_three_centers_ L2 - http://www.minervamedica.it/index2.t?show=R37Y2017N05A0643 DB - PRIME DP - Unbound Medicine ER -