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To evaluate early and midterm results of the Endurant stent-graft in the treatment of abdominal aortic aneurysms (AAAs).From November 2007 to December 2009, 156 patients (142 men; mean age 73.6 years, range 51-90) were treated with the Endurant stent-graft at our center. More than half (106, 67.9%) had hostile proximal neck anatomy. Early (30-day) technical success, clinical success, major morbidity, and mortality rates were analyzed, as well as estimated 2-year survival, freedom from types I/III endoleak, freedom from graft thrombosis, freedom from any device-related reinterventions, and factors affecting 2-year freedom from types I/ III endoleak.Immediate intraoperative technical and clinical success was achieved in all cases. In 14 (9%) cases with a proximal neck <5 mm long, a “chimney” technique was used. At discharge, computed tomography demonstrated 2 (1.3%) type I endoleaks. At 30 days, 4 (2.6%) patients had died (2 were urgent cases); the 30-day major morbidity was 7.7%. The overall 30-day technical success and clinical success rates were 98.7% and 95.5%, respectively. During a mean 9-month follow-up (range 1-24), 3 patients died (one of them from AAA rupture). Estimated survival, freedom from types I/III endoleak, freedom from graft thrombosis, and freedom from any device-related reinterventions at 2 years were 94.7%, 96.9%, 97.8%, and 92.6%, respectively.The Endurant stent-graft seems to be safe and effective in endovascular aneurysm repair (EVAR), even in patients with hostile aortoiliac anatomy. However, perioperative and midterm complications occur, which could be explained by the expansion of indications for EVAR. Further studies are needed to evaluate the long-term results.