Use of Endurant Stent-Graft Aortic Extensions for the Treatment of Focal Aortic Pathology

Ann Vasc Surg. 2016 Oct:36:99-105. doi: 10.1016/j.avsg.2016.03.017. Epub 2016 Jul 13.


Background: To describe our experience with the endovascular treatment of focal abdominal aortic pathology with an adequate distal neck length using Endurant (Medtronic) aortic extension cuffs.

Methods: From July 2010 to May 2015, 16 patients (14 male), with a mean age of 73.6 years (range, 59-88), were treated for focal abdominal aortic pathology using only Endurant (Medtronic) aortic cuff extensions. The indication for intervention was a saccular abdominal aortic aneurysm (AAA) in 5 patients, a fusiform aortic aneurysm in 6 patients, abdominal aortic dissection in 2 patients, an aortic juxtarenal rupture in 1 patient, a large anastomotic pseudoaneurysm of previous bifurcated open repair in 1 patient, and a juxtarenal aneurysm above a previous open AAA repair. Aortic lesions had a mean diameter of 52.9 (range, 32-90) mm. All patients were operated under local anesthesia with unilateral femoral exposure. A single 70-mm long Endurant aortic extension was deployed in 5 cases, while in the remaining 11 cases, 2 cuffs were used with the "telescopic" (double tube) technique. A chimney technique was performed in 5 cases (with a bare metal stent in the renal artery in 3 and a stent graft in the celiac artery in 2).

Results: The intraoperative technical success was 100% with no endoleaks on completion angiogram. There was no 30-day mortality. One patient developed acute limb ischemia immediately postoperatively and was treated successfully with thrombectomy. During a mean follow-up of 21.9 months, 1 patient died 2 months after the procedure due to cardiac arrest unrelated to his aortic operation. There was 1 early type IIb endoleak (present at the 30-day follow-up computerized tomography scan), which disappeared 10 months after the procedure. Finally, 1 patient was diagnosed with a type II endoleak and stable diameter 53 months postoperatively, while to date there are no cases of stent-graft migration.

Conclusions: The use of Endurant aortic extensions in aneurysms with adequate distal neck is a safe, simple, customizable, and cost-effective method which presents similar early results with standard endovascular aneurysm repair technique.

Publication types

  • Review

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aneurysm, False / diagnostic imaging
  • Aneurysm, False / surgery
  • Aorta, Abdominal / diagnostic imaging
  • Aorta, Abdominal / surgery*
  • Aortic Aneurysm, Abdominal / diagnostic imaging
  • Aortic Aneurysm, Abdominal / surgery
  • Aortic Diseases / diagnostic imaging
  • Aortic Diseases / surgery*
  • Aortic Dissection / diagnostic imaging
  • Aortic Dissection / surgery
  • Aortic Rupture / diagnostic imaging
  • Aortic Rupture / surgery
  • Aortography / methods
  • Blood Vessel Prosthesis Implantation / adverse effects
  • Blood Vessel Prosthesis Implantation / instrumentation*
  • Blood Vessel Prosthesis*
  • Computed Tomography Angiography
  • Endoleak / etiology
  • Endovascular Procedures / adverse effects
  • Endovascular Procedures / instrumentation*
  • Feasibility Studies
  • Female
  • Humans
  • Ischemia / etiology
  • Male
  • Middle Aged
  • Prosthesis Design
  • Retrospective Studies
  • Risk Factors
  • Stents*
  • Time Factors
  • Treatment Outcome