Laura van Zeggeren1, Joost A. van Herwaarden2, Hence J. Verhagen3, Debbie A. Werson1, Herman J. Zandvoort2, Frederico B. Goncalves3, Frans L. Moll2, Jean-Paul P. de Vries1
1Vascular Surgery, St. Antonius Hospital, Nieuwegein, Netherlands; 2University Medical Center, Utrecht, Netherlands; 3Erasmus Medical Center, Rotterdam, The Netherlands.
OBJECTIVES: The Endurant endograft was specially developed to broaden the treatment range for EVAR in patients with complex aortoiliac anatomy. Preliminary reports showed excellent outcome concerning migration and type IA endoleaks, but occurrence of post-EVAR obstruction has not been determined in a large patient cohort with mid-term follow-up (FU).
METHODS: Data of all consecutive patients treated with the Endurant from December 2007 to April 2011 in 3 Dutch tertiary referral hospitals were prospectively gathered. FU consisted of regular office visits, 1 and 12 months CT-scans, and annual duplex scanning thereafter. Patients with either a symptomatic stenosis or complete occlusion of the Endurant endograft were identified.
RESULTS: Four-hundred twenty-eight patients (88.3% male, mean age 73 years (range 47-89)) were treated. Median FU was 12 months (range 0-43). Twenty-two obstructions occurred in 21 patients (4.9%), either of the main body of the graft (n=3), a limb (n=18) or unknown (n=1). Median time to obstruction was 6 months (range 0-22), with 27.3% occurring >12 months post-EVAR. Presenting symptoms were acute ischemia (40.9%, Rutherford 2A-B) or non-acute (59.1%). The latter were mainly claudicants without rest pain, and diagnosed at regular FU. Treatment was surgical (63.6%) or percutaneous (18.2%), the remainder was left untreated due to mild clinical complaints. Initial treatment was successful in 19 of 22 obstructions (86.4%), but re-obstruction occurred in 6 (31.6%). In 40.9% of obstructions a graft related complication (kinking, stenosis or collapse) was found. Mortality due to obstruction of the endograft was 0.7% (3/428) in all patients, and 14.3% (3/21) in the obstruction group; 2 patients died because of ongoing ischemia, and 1 patient died intra-operatively due to bleeding.
CONCLUSIONS: Endurant endograft obstruction occurred in 4.9% of 428 patients, and continued during FU. It is an important complication that must be considered in expanding the indications for EVAR.
AUTHOR DISCLOSURES: J. P. de Vries: Medtronic, Consulting fees or other remuneration (payment); F. B. Goncalves, Nothing to disclose; F. L. Moll, Medtronic, Consulting fees or other remuneration (payment); J. A. van Herwaarden: Medtronic, Consulting fees or other remuneration (payment); L. van Zeggeren, Nothing to disclose; H. J. Verhagen, Medtronic, Consulting fees or other remuneration (payment), Medtronic, Research Grants; D. A. Werson, Nothing to disclose; H. J. Zandvoort, Nothing to disclose.
Posted April 2012