Original title: Outcomes of Endovascular Aneurysm Repair with 2 different Endograft Systems With Suprarenal Fixation in Patients With Hostile Infrarenal Aortic Anatomy. Reference: George A. Antomiuo et al. Vascular Endovascular Surgery 47(1):9-18

The unfavorable or hostile anatomy of abdominal aortic aneurysms is a limitation of endovascular treatment and is related to complications after implantation such as migration, the presence of leaks, reoperation and an increase in mortality and morbidity. 

The latest devices have incorporated improvements that achieve a more precise implant, better adaptability to the tortuous anatomy, a better proximal superior sealing, etc. For this study, unfavorable neck was considered in the presence of at least one of the following characteristics: neck length 60 °. Other structures such as the presence of thrombus or calcification were recorded but not considered as a criterion for the inclusion of patients. 

We included a total of 60 patients of which 27 received Zenith, (Cook Corp, Indianapolis, Indiana), and 33 Endurant, (Medtronic Cardiovascular, Santa Rosa, California). Clinical and anatomical characteristics in both groups were similar. The only significant difference was the increased use of general anesthesia in the Zenith group. Successful implantation was achieved in all patients of both groups, without the necessity of emergency surgery or conversion. In the track 18 ± 14, (1-47), months for the Zenith group and 14 ± 8, (1-26), months for the Endurant group, no significant differences were observed in the presence of leaks (Zenith 7 patients versus Endurant 3 patients; p = 0.068), reoperation (Zenith 4 patients versus Endurant 0 patients, log-rank test, p = 0.041) or all-cause mortality (Zenith 7 patients versus Endurant 2 patients, P = 0.087).

Conclusion: 

Similar results in terms of free survival of any leak and all-cause mortality can be achieved with both devices when treating patients with abdominal aortic aneurysms and proximal unfavorable neck anatomy.

Commentary: 

This analysis shows that it was not only feasible and safe to treat patients with an unfavorable anatomy with these devices but it also provided a favorable evolution at the medium term. 

Courtesy Dr Carlos Fava.
Interventional Cardiologist.
Favaloro Foundation. Buenos Aires, Argentina.

Dr. Carlos Fava para SOLACI.ORG