Long-Term Results After Standard Endovascular Aneurysm Repair With the Endurant and Excluder Stent Grafts
| Autor: | Hence J.M. Verhagen, Sander Ten Raa, Frederico Bastos-Gonçalves, Armando Mansilha, Nelson Oliveira, José Oliveira-Pinto, Sanne E. Hoeks, Marie Josee Van Rijn |
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| Přispěvatelé: | Surgery, Anesthesiology |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
Time Factors Databases Factual medicine.medical_treatment Postoperative Complications / etiology 030204 cardiovascular system & hematology Endovascular aneurysm repair Aortic aneurysm Postoperative Complications 0302 clinical medicine Risk Factors Stents Clinical endpoint 030212 general & internal medicine Endovascular Procedures Treatment Outcome Aortic Aneurysm Abdominal / mortality Female Blood Vessel Prosthesis Implantation / adverse effects Cardiology and Cardiovascular Medicine medicine.medical_specialty Blood Vessel Prosthesis Implantation / instrumentation Renal function Endovascular Procedures / instrumentation Aortic Aneurysm Abdominal / diagnostic imaging Prosthesis Design Blood Vessel Prosthesis Endovascular Procedures / adverse effects Blood Vessel Prosthesis Implantation 03 medical and health sciences Endovascular Procedures / mortality Blood vessel prosthesis medicine Humans Clinical significance Aged Retrospective Studies Aortic Aneurysm Abdominal / surgery business.industry Stent Retrospective cohort study medicine.disease Surgery HSM CIR VASC Blood Vessel Prosthesis Implantation / mortality business Aortic Aneurysm Abdominal |
| Zdroj: | Repositório Científico de Acesso Aberto de Portugal Repositório Científico de Acesso Aberto de Portugal (RCAAP) instacron:RCAAP Journal of Vascular Surgery, 71(1), 64-74. Mosby Inc. |
| ISSN: | 0741-5214 |
| Popis: | Objective: Many endografts are currently available for standard endovascular repair of infrarenal abdominal aortic aneurysms. Comparison of long-term outcomes between devices might aid in this decision process, but comparative data are scarce. The purpose of this study was to report long-term clinical outcomes of two commercially available endoprosthesis, the Endurant (Medtronic Vascular, Inc, Minneapolis, Minn) and the Excluder (W. L. Gore & Associates, Flagstaff, Ariz) stent grafts. Methods: Patients undergoing standard endovascular repair from July 2004 to December 2011 in a single institution with the Endurant or the Low-Porosity Excluder endografts were eligible. Only patients treated for intact degenerative abdominal infrarenal aneurysms were included. All measurements were performed on center-lumen line reconstructions obtained on dedicated software. The primary end point was primary clinical success, defined as clinical success without the need for an additional or secondary surgical or endovascular procedure. Neck-related events (a composite of type IA endoleak, neck-related secondary intervention, or migration of >5 mm), neck morphology changes, renal function, and overall survival were secondary end points. Results: The study included 277 patients (156 Endurants; 121 Excluders). The median follow-up was 5.8 years (range, 0.1-12.4 years) and did not differ between groups (P = .18). Patients treated with the Endurant stent graft had wider (neck diameter of >28 mm, 27.3% vs 1.7% [P < .001]; neck diameter of 27 mm, [interquartile range (IQR), 24-29 mm] for Endurant and 24 mm [IQR, 22-25 mm] for Excluder; P < .001) and more angulated necks (β-angle of >60°, 26.7% vs 12.5%; P = .004). Oversizing was greater in the Endurant group (16% [IQR, 12%-22%] vs 13% [IQR, 8%-17%], respectively; P < .001). Patients were treated outside device instructions for use regarding proximal neck: 16.7% in the Endurant and 17.3% in the Excluder group (P = .720). The 7-year primary clinical success was 54.7% for the Endurant and 58.1% for the Excluder groups (P = .53). Freedom from neck-related events at 7 years was 76.7% for the Endurant and 78.8% for Excluder group (P = .94). The Endurant stent graft (hazard ratio [HR], 2.7; 95% confidence interval [CI], 1.3-5.8; P = .009) was an independent predictor of significant renal function decline. Neck dilatation was greater in Endurant-implanted patients (13% [95% CI, 2%-22%] vs 4% [95% CI, 0%-10%]; P < .001). Overall survival at 7 years was 61.4% in the Endurant and 50.3% (n = 50; standard error, 0.047) in the Excluder group (P = .39). Conclusions: This study reveals that durable and sustainable results can be obtained with either of these late generation devices. This finding suggests that careful planning and a tailored device selection taking into account the patient's anatomy are more relevant determinants than the graft model itself to obtain clinical success. The Endurant endoprosthesis seems to be associated with a higher rate of neck dilatation and faster decrease in the estimated glomerular filtration rate, but further studies with longer follow-up are necessary to determine the clinical relevance of these findings. info:eu-repo/semantics/publishedVersion |
| Databáze: | OpenAIRE |
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