Editor's Choice – Five Year Outcomes of the Endurant Stent Graft for Endovascular Abdominal Aortic Aneurysm Repair in the ENGAGE Registry

Abstract

WHAT THIS PAPER ADDS Analysis of the performance of modern stent grafts is necessary as earlier generation stent grafts are associated with an increased need for secondary interventions. Five year follow up of patients treated with the Endurant stent graft in the ENGAGE registry demonstrates better survival and lower rates of endoleaks, stent migration, and re-intervention. Longer term follow up to 10 years will be necessary to compare fully the advantages of endovascular aneurysm repair against open repair. However, these mid-term results show the Endurant stent graft was successful in treating a large cohort of patients with a wide range of anatomies. Objective/background: Endovascular abdominal aortic aneurysm repair (EVAR) is commonly used to treat abdominal aortic aneurysm (AAA). However, the incidence of long-term complications and the need for reinterventions after EVAR remain a concern. Newer generation stent grafts have encouraging short and midterm outcomes, but thorough analysis of their long-term performance is necessary. Methods: The ENGAGE registry includes a total of 1263 patients with AAA enrolled from March 2009 to April 2011 at 79 centres across 30 countries. The aim of this study is to present standard EVAR outcomes in the registry after five years. Results: A significant proportion of the ENGAGE patients presented with challenging features, such as 15.2% with an AAA diameter >7 cm, 12.0% with proximal neck lengths <15 mm, and 10.2% with infrarenal neck angles >60. Of the 1263 enrolled subjects, 17.8% were implanted outside of the instructions for use for the device. At the five year follow up, the KaplaneMeier overall survival rate was 67.4% and the freedom from aneurysm related mortality was 97.8%. Freedom from aneurysm rupture, secondary procedures, and conversion to open repair at five years were 98.6%, 84.3%, and 97.9% respectively. The five year freedom from type IA endoleaks was 95.2% and for type III endoleaks 97.4%. Aneurysm sac diameter at five years was observed to have either decreased !5 mm in diameter or remained stable in 89.4% of the patients. Conclusion: Five year follow up of patients in the ENGAGE registry demonstrates sustained safety, effectiveness, and durability in an international cohort that is reflective of real world experience. Additional follow up is expected through to 10 years.

Outcomes of Endovascular Aneurysm Repair Using the Anaconda Stent-Graft

“…During the 5-year follow-up of patients treated with the Endurant stent-graft from the Engage registry, aneurysm-related mortality was 2.2% and freedom from aneurysm rupture was 98.6%. 28 Long-term follow-up to 10 years from vascular centers around the world is necessary to provide important information regarding the durability and efficacy of EVAR with different types of stent-grafts.…”

Editor's Choice – Systematic Review of the Use of Endoanchors in Endovascular Aortic Aneurysm Repair

“…In comparison, the rate of graft migration in the ENGAGE registry was 0.3% at five year follow up. 26 This is lower than results from earlier EVAR literature with rates of 2.9e4.0%, which may in part be attributed to improvements in stent graft technology. 31,32 Only the Endurant stent graft system (W.L.…”

“…In comparison, pooled data from the EVAR-1, DREAM, OVER, and ACE trials report an overall TIaE rate of 4.3%, 24 whereas more recently published five year follow up from the GREAT and ENGAGE registeries report a TIaE rate of 2.7% and 4.8%, respectively. 25,26 The only relatively comparable controlled data are from a retrospective propensity matched control study from the ANCHOR registry which failed to demonstrate a significant difference in the rate of TIaE between endoanchored and non-endoanchored patients. 27 The main interest in endoanchors, however, is in patients with challenging aortic neck anatomy, in whom TIaE rates may reach as high as 10%.…”

The Polymer-Based Technology in the Endovascular Treatment of Abdominal Aortic Aneurysms

“…EVAR has gained wide acceptance as the preferred method to treat patients with AAA [1,[23][24][25][26][27][28]. The standard endovascular procedure involves a stent-graft that is designed to exclude the aneurysm from the systemic circulation (Figure 1).…”