Endurant Stents in Abdominal Aortic Aneurysm Repair: A Systematic Review and Meta-Analysis

Objectives: New endografts have improved clinical outcomes in patients with abdominal aortic aneurysm (AAA) treated with the endovascular approach (EVAR). The purpose of this study is to evaluate the Endurant endograft for EVAR. Methods: A systematic search was conducted in PubMed, Scopus, and Cochrane for studies including patients treated with EVAR for unruptured AAA. This meta-analysis follows PRISMA guidelines (PROSPERO: CRD42024621517). A Kaplan-Meier-derived individual patient data analysis assessed the survival, the freedom from reintervention, the freedom from type Ia endoleak (ETIa), and the aneurysm-related mortality rates. The analysis reflects aggregated survival data, and the at-risk population decreases over time due to censoring and loss to follow-up. Kaplan-Meier survival curves were digitized to extract survival/mortality values at specific time points, and number-at-risk tables or total events were used to improve time-to-event accuracy. A subgroup analysis compared the outcomes of treatment within versus outside the instructions for use (IFU). Results: Twenty-six studies met our eligibility criteria, incorporating 5901 patients in terms of survival, with survival rates at 1, 5, and 10 years of follow-up at 94.4%, 71.6%, and 42.4%, respectively, while overall aneurysm-related mortality rates were 0.8%, 2.3%, and 7.6%, respectively. Freedom from secondary reintervention was 94.9% at 1 year, 81.9% at 5 years, and 43.7% at 10 years, while freedom from type Ia endoleak was 98.8%, 94.6%, and 85.6%, respectively. Comparing treatment within versus outside the IFU, in terms of survival (HR: 0.94, 95% CI: 0.75-1.16, p = 0.53), freedom from reintervention (HR: 0.85, 95% CI: 0.63-1.15, p = 0.29) and mortality due to aneurysm-related complication (HR: 0.79, 95% CI: 0.34-1.84, p = 0.58) revealed no statistically significant difference. Conclusions: The Endurant endograft provides acceptable rates of survival, freedom from secondary intervention, aneurysm-related mortality rates, and freedom from ETIa; however, continuous long-term follow-up surveillance is necessary.