Abstract
ObjectiveThe technical evolution of endografts for the interventional management of infrarenal abdominal aortic aneurysms (AAA) has allowed a continuous expansion of indications. This study compares the established Talent endograft with its successor, the Endurant endograft, taking individual aortoiliac anatomy into account.MethodsFrom June 2007 to December 2010, 35 patients with AAA were treated with a Talent endograft (33 men) and 36 patients with an Endurant endograft (34 men). Aortoiliac anatomy was evaluated in detail using preinterventional computed tomography angiography. The 30-day outcome of both groups were compared regarding technical and clinical success as well as complications including endoleaks.ResultsThe Endurant group included more patients with unfavorable anatomy (kinking of pelvic arteries, p = 0.017; shorter proximal neck, p = 0.084). Primary technical success was 91.4% in the Talent group and 100% in the Endurant group (p = 0.115). Type 1 endoleaks occurred in 5.7% of patients in the Talent group and in 2.8% of those in the Endurant group (p = 0.614). Type 3 endoleaks only occurred in the Talent group (2.9% of patients; p = 0.493). Type 2 endoleaks were significantly less common in the Endurant group than in the Talent group (8.3% versus 28.6%; p = 0.035). Rates of major and minor complications were not significantly different between both groups. Primary clinical success was significantly better in the Endurant group (97.2%) than in the Talent group (80.0%) (p = 0.028).ConclusionEndurant endografts appear to have better technical and clinical outcome in patients with difficult aortoiliac anatomy, significantly reducing the occurrence of type 2 endoleaks.
Highlights
Endovascular aneurysm repair (EVAR) has become the method of choice for treating infrarenal abdominal aortic aneurysms (AAA)
In addition to aortoiliac anatomy, the material of which a stent-graft is made and the endograft design are other important factors contributing to outcome after EVAR [3,4,5,6]
Aortoiliac Anatomy The proximal neck had a mean length of 3.9660.19 cm in the Talent group and was on average 0.75 cm shorter in the Endurant group (3.2161.35 cm, p = 0.084)
Summary
Endovascular aneurysm repair (EVAR) has become the method of choice for treating infrarenal abdominal aortic aneurysms (AAA). This is largely due to its minimal invasiveness and the continuously improved outcome with low morbidity and mortality [1,2]. In addition to aortoiliac anatomy, the material of which a stent-graft is made and the endograft design are other important factors contributing to outcome after EVAR [3,4,5,6]. A great variety of different models and manufacturers are currently available They differ in basic design, the endograft material used, the site of proximal fixation, and the presence of anchoring hooks or pins at the proximal graft end. Improved stent-grafts can be used for EVAR in patients with difficult aortoiliac anatomies such as short proximal necks, severely angulated infrarenal aortas, and kinking or heavy calcification of pelvic arteries [4,7,8]
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