The Performance of the Endurant Endoprosthesis in an Infrarenal Aortic Aneurysm with a Wide or Conical-Shaped Infrarenal Neck Anatomy

<b>Background/Objectives:</b> Wide and conical-shaped infrarenal necks are risk factors for neck-related complications after Endovascular Aorta Aneurysm Repair (EVAR). The aim of this study is to investigate the performance of the Endurant endoprosthesis in wide/conical-shaped aortic neck anatomies compared to its performance in a normal infrarenal neck (reference group). <b>Methods</b>: A single-center, retrospective observational cohort study was performed, including consecutive subjects with an infrarenal abdominal aortic aneurysm, treated electively with an Endurant endoprosthesis. The primary endpoint was the freedom from aneurysm-related reinterventions through 1 year. Secondary endpoints included proximal fixation failure, type IA endoleak, stent migration, aneurysm sac remodeling, aneurysm-related mortality, freedom from reinterventions throughout available follow-up, and rupture. <b>Results</b>: A total of 268 patients were included, with a mean age of 73.3 years, and 85.1% were male. Freedom from aneurysm-related reinterventions was significantly lower in the wide-neck group (60.0%) compared to the reference group (81.1%; <i>p</i> = 0.018) but not for the conical-neck group (70.3%; <i>p</i> = 0.286). Median time to first reintervention was 1.7 (IQR 0.8; 4.4 years) in the reference group, 2.9 years (IQR 0.3; 5.0 years) in the wide-neck group (<i>p</i> = 0.547) and 3.8 years (IQR 0.4; 6.5) in the conical-neck group (<i>p</i> = 0.123). The proximal fixation failure rate was 7.4% in the wide-neck group compared to 3.3% in the reference group (<i>p</i> = 0.155) and 1.7% in the conical-neck group (<i>p</i> = 0.525). The type IA endoleak rate was 4.9% in the wide-neck group versus 3.3% in the reference group (<i>p</i> = 0.250). <b>Conclusions</b>: In the group with wide necks, reintervention-free survival was lower compared to the reference group, which seems to be driven by proximal fixation failure.