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

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.