Outcomes of EVAR with the endurant stent-graft system in patients with infrarenal ruptured abdominal aortic aneurysms: Is hostile anatomy a challenging factor?

Highlights • In this study, primary outcome measures (POM) were procedure-related mortality, 30-day mortality, and survival rate at 1 year in patients with ruptured AAAs and which were treated with Endurant stent-grafts. Secondary outcome measures (SOM) were technical success, open surgical conversion, complications, survival, relationship between size-severity of the rAAA and mortality, procedure time, hospital stay. • In patients with rAAAs, the periprocedural EVAR mortality rate was 33%. The overall mortality rate without prehospital phase deaths was 40%. Seventy three percent of the patients with rAAAs had hostile anatomy. • This retrospective analysis demonstrated that there were no statistically significant differences between the groups considering POMs and SOMs (except hospital stay). Mean hospital stay was shorter in the normal anatomy group. • The presence of a hematoma extending into the pelvis or suprarenal space, or to both sides of the aorta, and free intraperitoneal blood resulted in higher mortality. • Fifty four percent of the patients with hostile anatomy survived after the EVAR of rAAAs, without significant major complications. • EVAR of rAAAs with hostile anatomy is feasible. • Off-label use of Endurant-I endografts could be expanded.