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DOI: 10.1055/s-0029-1246979
Single-centre experience with the new ENDURANT® stentgraft device – pros and cons
Objectives: To be suitable for patients with challenging anatomy (e.g. aneurysm with an angulated or short neck), the ENDURANT® stentgraft (Medtronic) is equipped with proximal anchoring pins to prevent migration. The flexibility of the graft and application device has also been improved. The stentgraft relies on 30% less radial force and has a short M-shaped proximal sealing stent to enhance its sealing capability. This study was initiated to evaluate the ENDURANT®'s in vivo performance and to discover any associated product and procedure-specific issues.
Methods: Since October 2008, 31 patients with abdominal aortic pathologies received ENDURANT®-prostheses in the University Medical Center Mainz. Stentgrafts were selected according to individual anatomical conditions and underlying aortic pathology. Pre- and post-operative aortic diameter, ICU and in-hospital stay as well as patients' outcome were evaluated.
Results: After a 5-month follow-up, we observed stentgraft-associated complications in 5 patients (3 partial limb stentgraft thrombosis and 2 endoleaks). Minor surgical access complications occurred in 3 patients (2 wound infection, 1 lymph fistula). No patient died during follow-up.
Conclusions: Critical monitoring of new stentgrafts' long-term results in multicentre clinical trials, like the ENGAGE registry, is mandatory. Our observations have convinced us of the need to broaden the indication for stentgraft ballooning after deployment and for more aggressive anticoagulation therapy (aspirin and clopidogrel). Each of our patients underwent CT-scan before discharge, after 3, 6 and 12 months and annually thereafter. In case of any partial limb stentgraft thrombosis, we used successfully additional non-covered stentgrafts for re-intervention.