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37th Annual VEITH  Symposium 2010  Contemporary One year    EVAR Outcomes from the US IDE trial and ENGAGE Global Registry of the Endurant AAA Endograft Device Michel S. Makaroun MD Division of Vascular Surgery University of Pittsburgh for the US Endurant Pivotal Trial Investigators
The Bifurcated Endurant EndoGraft Description Modular Stent-Graft Multi-filament Polyester Fabric Electropolished Nitinol Stent Active Suprarenal fixation   3 cm Overlap Zone Pt-Ir and Gold Markers                                                                  Endurant
The Bifurcated Endurant EndoGraft ,[object Object]
Limb stent geometry designed for flexibility
One-piece, laser-cut, Nitinol suprarenal stent with anchoring pins,[object Object]
Controlled release of the suprarenal anchoring pins,[object Object]
Endurant Delivery System Allows for Slow Deliberate  and Accurate Proximal Deployment
The Endurant EndoGraft
The Endurant US Regulatory Study ,[object Object]
26 sites: Both Academic and Community Hospitals
150 patients
April 2008  to May 2009
One year follow-up visits completed
All Imaging reviewed by a Core Lab (M2S)
Clinical Events Committee (CEC) adjudicated           all untoward events,[object Object]
Neck length ≥ 10 mm
Neck angulation ≤ 60 degrees
Iliac Fixation length ≥ 15 mm
Suitable AccessEndpoints ,[object Object]
Effectiveness endpoint: Composite of Technical and Clinical Success of AAA Rx @ 1 year,[object Object]
The Endurant US Regulatory Study Demographics
The Endurant US Regulatory Study Procedure One AAA ruptured during the procedure which was still completed successfully
The Endurant US Regulatory Study 30 Day Results  ,[object Object]
Major Adverse Event (MAE)	4.0% (6/150)Myocardial Infarction			0.7% (1/150) 	Renal Failure				0.7% (1/150) 	Respiratory Failure			1.3% (2/150) 	Stroke					0.7% (1/150) 	Bowel Ischemia				1.3% (2/150) 	Procedural Blood Loss  ≥ 1000cc	0.7% (1/150) ,[object Object],[object Object]
The Endurant US Regulatory Study Long Narrow Neck Rx: Fem-Fem Distal Neck 15mm Right EIA   4 mm CT on Day 20    Compressed  and  Occluded R Limb
The Endurant US Regulatory Study 30 Day Results  ,[object Object],Pulmonary Complications		3.3% (5/150) 	Renal Complications			2.0% (3/150) 	CHF						2.0% (3/150) 	Fever						6.0% (9/150) 	Urologic					4.7% (7/150) 	Wound Complications			0.7% (1/150) 	Arterial Events				4.0% (6/150)
The Endurant US Regulatory Study Follow-up ,[object Object]

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AHA: Endurant veith 2010

Editor's Notes

  1. Endurant implanted (826/829)Endurant not implanted in 3 patients:Subject 05001-018: Implanting physician could not get device through iliac system,iliac arteries calcified circumferentially and tortuous. Diameter Left iliac: 13mm (Right iliac: 18mm) Subject 10201-009: One pin remained under the cap. System could not be deployed or retracted. Pt. converted. This was 1st generation spindle design.Medtronic has made improvements to the spindle edges to make them smoother and much less prone to getting caught up.Subject 10312-15 had an implant attempt, but was not implanted with the Endurant device. This patient is a 62 yr old Male patient (152cm and 44kg) with a maximum AAA diameter of 48 mm. Investigator narrative: ‘Patient 10312-015 was a complex problem. This patient needed to undergo the index procedure on a short term. For that reason we used some devices from our own stock. We first placed the iliac extension, with the idea of placing the main body here after through this extension. Eventually this failed and the main body ended up too high in the aorta, and covered both renal arteries. This case is an estimation- and/or measurement error’. During the procedure it was decided to convert the case to open surgery.Patients were converted to open surgery