PS20. Long-term Results of Talent Endografts for Endovascular Abdominal Aortic Aneurysm Repair

Abstract

Since introduction of EVAR, long-term follow-up studies reporting single device results are scarce. In this study we focus on the Talent® endograft. Between July 2000 and December 2007 366 patients underwent elective EVAR repair. Patient data were gathered prospectively and retrospectively evaluated. 74% of the patients were diagnosed ASA III and IV. Postoperative CT-scanning was performed before discharge, 6, 12 months and yearly thereafter. Data are presented according to reporting standards for EVAR (Chaikof et.al, J VS 2002) Mean proximal aortic neck diameter was 27 mm, with a neck length ≤15 mm in 31% (data available for 193 cases). Deployment of endografts was successful in 99% (362/366) of patients. Initially conversion to laparotomy was necessary in 4 cases. Primary technical success based upon results from CT-scans before discharge was achieved in 91% (332/366). 8% (28/366) patients had proximal type 1 endoleaks; during follow-up 14/28 patients needed additional treatment. 30-day mortality was 1.4% (5/366). Follow-up is reported till 84 months (n = 24 at 84 months). 34% (123/366) patients died during follow-up. In five patients mortality was AAA related (2 ruptured). Kaplan Meier estimates revealed primary clinical success rates of 98% at 1 year, 93% at 2 years, 88% at 3 years, 79% at 4, 64 % at 5 years, 51% at 6 years and 48% at 7 years, respectively. Secondary interventions had to be performed in 18% (66/366) of patients. Ten open conversions for failed endografts were performed. Life table yearly risk for AAA related reintervention was 6%, yearly risk for conversion 1.1%, and yearly risk for AAA-related mortality was 0.8%. Initially technical success of EVAR using the Talent endograft is high, with low yearly risk for AAA-related mortality and conversion. However, a substantial amount of -mainly endovascular- reinterventions is necessary during long-term follow-up to achieve these results