Talent Stent Graft Research Articles

Comparison of midterm results for the Talent and Endurant stent graft

ObjectiveStent graft evolution is often addressed as a cause for improved outcomes of endovascular aneurysm repair for patients with an abdominal aortic aneurysm. In this study, we directly compared the midterm result of Endurant stent graft with its predecessor, the Talent stent graft (both Medtronic, Santa Rosa, Calif). MethodsPatient treated from January 2005 to December 2010 in a single tertiary center in The Netherlands with a Talent or Endurant stent graft were eligible for inclusion. Ruptured abdominal aortic aneurysms or patients with previous aortic surgery were excluded. The primary end point was the Kaplan-Meier estimated freedom from secondary interventions. Secondary end points were perioperative outcomes and indications for secondary interventions. ResultsIn total, 221 patients were included (131 Endurant and 90 Talent). At baseline, the median aortic bifurcation was narrower for the Endurant (30 mm vs 39 mm; P < .001). Median follow-up was 64.1 ± 37.9 months and 59.2 ± 25.3 months for Talent and Endurant, respectively. The estimated freedom from secondary interventions at 30 days, 1 year, 5 years, and 7 years was 94.3%, 89.4%, 72.2%, and 64.1% for Talent and 96.8%, 89.3%, 75.2%, and 69.2% for Endurant (P = .528). The indication for secondary interventions does differ; more patients required an intervention for a proximal neck-related complication (type Ia endoleak or migration) in the Talent group (18.2% vs 4.8%; P = .001), whereas more interventions for iliac limb stenosis were seen in the Endurant group (0.0% vs 4.8%; P = .044). In a binomial regression analysis, suprarenal angulation, infrarenal neck length, and type of stent graft were independent predictors of neck-related complications. ConclusionsEvolution from the Talent stent graft into the Endurant has resulted in significant reduction of infrarenal neck-related complications; on the other hand, iliac interventions increased. The overall midterm secondary intervention rate was comparable.

Endovascular Repair of the Ascending Aorta: When and How to Implement the Current Technology

The purpose of our study was to examine when and how to implement the current endoluminal stent graft technology to treat ascending aortic disease. During a 7-year period (March 2006 through July 2013), 7 consecutive patients (median age, 69 years; range, 61.5 to 80.5 years) with multiple comorbidities underwent endoluminal repair of the ascending aorta. Six had an ascending aortic pseudoaneurysm, and 1 had iatrogenic coarctation. The median number of prior sternotomies was 2 (range, 1 to 4). Technical success was achieved in all but 1 patient, with 1 death (14.3%) at 30 days. The endoluminal technology used included the Gore TAG (W.L. Gore and Associates, Flagstaff, AZ) thoracic graft (including the new C-TAG) in 6 patients, the Talent stent graft (Medtronic, Santa Rosa, CA) in 1, an Excluder cuff (W.L. Gore) in 2, and an Amplatzer occluder (AGA Medical Corp, Plymouth, MN) in 1. More than 1 stent was placed in 4 patients. Three patients required innominate artery stenting, and 1 required additional left common carotid artery stenting. One patient (14.3%) required intraoperative conversion to open surgical repair. Median follow-up was 14.4 months (interquartile [25th to 75th percentile] range, 5.5 to 22.6 months) with 66.6% overall survival. No aortic-related death was reported during the follow-up period. Stent grafting of the ascending aorta is feasible but limited and is reserved for high-risk individuals. Technical expertise is essential, and follow-up is mandatory. Technical points, tips, and challenges of the current endovascular technology to effectively treat the ascending aorta are described.

Finite Element Analysis of the Mechanical Performances of 8 Marketed Aortic Stent-Grafts

To assess numerically the flexibility and mechanical stresses undergone by stents and fabric of currently manufactured stent-grafts. Eight marketed stent-graft limbs (Aorfix, Anaconda, Endurant, Excluder, Talent, Zenith Flex, Zenith LP, and Zenith Spiral-Z) were modeled using finite element analysis. A numerical benchmark combining bending up to 180° and pressurization at 150 mmHg of the stent-grafts was performed. Stent-graft flexibility, assessed by the calculation of the luminal reduction rate, maximal stresses in stents, and maximal strains in fabric were assessed. The luminal reduction rate at 90° was <20% except for the Talent stent-graft. The rate at 180° was higher for Z-stented models (Talent, Endurant, Zenith, and Zenith LP; range 39%-78%) than spiral (Aorfix, Excluder, and Zenith Spiral-Z) or circular-stented (Anaconda) devices (range 14%-26%). At 180°, maximal stress was higher for Z-stented stent-grafts (range 370-622 MPa) than spiral or circular-stented endografts (range 177-368 MPa). At 90° and 180°, strains in fabric were low and did not differ significantly among the polyester stent-grafts (range 0.5%-7%), while the expanded polytetrafluoroethylene fabric of the Excluder stent-graft underwent higher strains (range 11%-18%). Stent design strongly influences mechanical performances of aortic stent-grafts. Spiral and circular stents provide greater flexibility, as well as lower stress values than Z-stents, and thus better durability.

Reply to ‘Review of postoperative CT and ultrasound for endovascular aneurysm repair using Talent stent graft: can we simplify the surveillance protocol and reduce the number of CT scans?’

Reply to ‘Review of postoperative CT and ultrasound for endovascular aneurysm repair using Talent stent graft: can we simplify the surveillance protocol and reduce the number of CT scans?’

Review of postoperative CT and ultrasound for endovascular aneurysm repair using Talent stent graft: can we simplify the surveillance protocol and reduce the number of CT scans?

Review of postoperative CT and ultrasound for endovascular aneurysm repair using Talent stent graft: can we simplify the surveillance protocol and reduce the number of CT scans?

Review of postoperative CT and ultrasound for endovascular aneurysm repair using Talent stent graft: Can we simplify the surveillance protocol and reduce the number of CT scans?

Simplifying a postoperative surveillance protocol for endovascular aneurysm repair (EVAR) requires quality control comparing computerized tomography (CT) and ultrasound (US) results of abdominal aortic aneurysm (AAA) diameter measurements and endoleaks. To test if US is comparable to CT, then assess a simplified follow-up with our conventional surveillance to assess patient safety. During 2001-2006, data on 56 patients treated with Talent stent graft were prospectively registered. Median follow-up was 41.5 months (range, 2-94 months), with CT, US, and plain film abdomen X-rays (PFA) at 1, 6, and 12 months, then yearly. Bland-Altman plot was used to assess the agreement between CT and US measuring the AAA diameters and mixed model by the time effect to assess the difference in diameter over time. Sensitivity and specificity for detection of endoleaks by US, with CT as 'gold standard' were calculated. A simplified surveillance protocol with US/PFA at 6 and 8 weeks, CT/US/PFA at 1 year, and yearly US/PFA thereafter, was evaluated. CT was carried out when poor visibility, endoleak detected, AAA diameter increase (≥5 mm) on US or migration (≥10 mm) on PFA. This regime was compared with our conventional follow-up protocol. Diameter measurements on US appear comparable to CT with 91% specificity and 85% sensitivity for endoleaks detected by US. Using the simplified surveillance protocol no endoleaks, migrations, or endotension requiring treatment were overlooked. The simplified protocol generated 53 selective CT scans, avoiding approximately 144 CT scans. If further simplified by omitting the 1-year CT scan, one type II endoleak would be missed with a 1-year delay, eliminating a further 45 CT scans. US appears comparable to CT in the follow-up of Talent stent grafts in our institution. The proposed simplified surveillance protocol seems safe and can lead to a significant reduction in the number of CT scans.

Scallop Technique of Urgent Endovascular Repair for Symptomatic Throacoabdominal Aortic Aneurysm With a Ready-Made Device

A 72-year-old woman had a large thoracoabdominal aortic aneurysm (TAAA) with abdominal pain. This aneurysm involved the celiac artery and the superior mesenteric artery (SMA). The risk of open surgery was very high due to severe comorbidity, and there was no appropriate distal attachment for thoracic endovascular repair (TEVAR) with ready-made devices. Therefore, TEVAR with the scallop technique was performed in this urgent setting. A scallop was created in a Talent thoracic stent graft. The aneurysm was successfully excluded, and perfusion in the SMA was preserved using this scalloped endograft. The scallop technique with a ready-made device may be one of the treatment options for urgent TAAA.

Long-Term Resistance to Fracture and/or Corrosion of the Nitinol Wires of the Talent Stent-Graft: Observations From a Series of Explanted Devices

The biodurability of the Nitinol wires used in stent-grafts retrieved from reoperations and autopsy was analyzed to assess the possible causes of fracture and/or corrosion of the stents. The Nitinol wires of six explanted devices presented a corrosion-free surface after in vivo service. The drawing lines in the control wires were still present, but neither burrs nor flakes were observed. Pits and crevices were rare, but some shallow ones were present. Some abrasions of the surfaces of the Nitinol wires were also observed. The chemical composition of the explanted devices showed the presence of organic contamination that covered the thick layer of titanium oxide before reaching the Nitinol itself. The durability of the Nitinol employed in the manufacture of the Talent stent-grafts was confirmed; the results of this study show the Nitinol to be resistant to corrosion. We have also concluded that the fractures of the Nitinol wires in two devices were unique adverse incidents caused by compression and bending related to the sharp angle of the Nitinol wires.

Catheterization of the Lumbar Artery via the Superior Mesenteric Artery During Type 2 Endoleak Treatment.

A 72-year-old man with an infrarenal aortic aneurysm was successfully treated with a Talent stent graft 39 months ago. The aneurysm sac size increased approximately 2 mm on a computed tomography (CT) angiogram recently, and type 2 endoleak was diagnosed. A CT angiogram demonstrated lumbar artery and inferior mesenteric artery (IMA) involvement. We planned to treat the type 2 endoleak via the superior mesenteric artery (SMA) to the IMA approach. A 6-F Ansel sheath and a 5-F Berenstein catheter were placed at the origin of the SMA. Then, an Echelon microcatheter was advanced at the origin of the 3rd lumbar artery via the arc of Riolan, IMA, and aneurysm sac, and the type 2 endoleak was identified. Embolization of the lumbar artery origin and the aneurysm sac was performed with eight Concerto detachable coils with sizes between 3–6 mm. Then, embolization of the aneurysm sac and at the origin of the IMA was performed with four Cosmos detachable coils with sizes between 6–10 mm. Follow-up SMA angiograms after the completion of the procedure and after a month demonstrated successful embolization without any complications. We are presenting this case because type 2 endoleak treatments with IMA embolization via the SMA are rare but not new, and it is not a simple procedure [1]. In particular, passing the Riolan arc with the microcatheter is hard because of its angled nature. Recently available low-profile devices are allowing further progress with lumbar artery access and successful embolization.

Pivotal results for the Medtronic Valiant Thoracic Stent Graft System in the VALOR II trial

We report 30-day and 12-month results of endovascular treatment with the Valiant Thoracic Stent Graft System (Medtronic Vascular, Santa Rosa, Calif) in patients with descending thoracic aortic aneurysms of degenerative etiology. The Valiant stent graft is an evolution of the Talent thoracic stent graft (Medtronic Vascular). The VALOR II (Evaluation of the Clinical Performance of the Valiant Thoracic Stent Graft System in the Treatment of Descending Thoracic Aneurysms of Degenerative Etiology in Subjects Who Are Candidates for Endovascular Repair) was a prospective, nonrandomized, pivotal trial conducted at 24 U.S. sites with enrollment between December 2006 and September 2009. Standard follow-up examinations, including physical examination, computed tomography, and chest radiography, were at 1, 6, and 12 months, and annually through 5 years. VALOR II outcomes were compared with those from the pivotal VALOR (Evaluation of the Medtronic Vascular Talent Thoracic Stent Graft System for the Treatment of Thoracic Aortic Aneurysms) trial of the Talent stent graft, which enrolled 195 patients with similar enrollment criteria. VALOR II enrolled 160 patients. Compared with VALOR patients, VALOR II patients had similar age and sex distribution but higher rates of cardiovascular risk factors and significantly more severe modified Society for Vascular Surgery/American Association for Vascular Surgery risk scores. Stent graft delivery and deployment were successful in 154 patients (96.3%). Outcomes at 30 days in VALOR II were perioperative mortality, 3.1%; major adverse events, 38.1%; paraplegia, 0.6%; paraparesis, 1.9%; and stroke, 2.5%. At 12 months, after the minimum sample size was reached, 151 patients were evaluated: aneurysm-related mortality was 4.0%, stent graft migration was 2.9%, and endoleak was 13.0%. Through 12 months, there were no ruptures, conversions to open surgery, secondary procedures due to endoleak >30 days, or loss of stent graft patency. The Valiant stent graft was statistically noninferior to the Talent stent graft in 12-month all-cause mortality (12.6% vs 16.1%) and exceeded the primary effectiveness goal of 12-month successful aneurysm treatment, defined as absence of aneurysm growth >5 mm and of secondary procedures for type I/III endoleak (97.4% vs 80.0%). The VALOR II 12-month results demonstrate that the Medtronic Valiant thoracic stent graft is a safe and effective treatment for patients with descending thoracic aortic aneurysms of degenerative etiology.

Technique for Branched Thoracic Stent-Graft Repair of a Chronic Type A Aortic Dissection in a Patient With Multiple Prior Sternotomies

To present a technique for endovascular treatment of a type A aortic dissection in a patient with multiple prior sternotomies and multiple medical comorbidities. The method is illustrated in a 76-year-old man with a history of hypertension, hyperlipidemia, coronary artery disease, and open repair of a type A aortic dissection via a median sternotomy. The latter procedure was complicated by a pericardial effusion requiring drainage and sternal re-wiring. The diameter of the residual type A dissection beginning just distal to the aortic root had increased by 1.5 cm over 1 year, indicating the need for further intervention. To avoid redo sternotomy, a hybrid endovascular approach was planned, but it would require landing the stent in the ascending aortic arch, thus mandating branch vessel revascularization. Prior to stent-graft deployment, right-to-left carotid-carotid and left carotid-subclavian artery bypasses were performed with 8-mm polytetrafluoroethylene grafts. Three Talent grafts were deployed from the celiac artery to the left subclavian artery. A pre-wired homemade branched Talent stent-graft (34×34×115 mm) was used to revascularize the innominate artery and secure the arch. Transvenous ventricular pacing was used to improve deployment accuracy. A 10×38-mm iCast stent was placed through the branch and extended into the innominate artery. The subclavian artery was occluded with 2 Amplatzer plugs. Postoperative computed tomography demonstrated excellent proximal fixation, a widely patent branched graft to the innominate artery, and thrombosis of the aneurysmal false lumen. Treatment of type A dissections remains a difficult surgical challenge. The approach taken should be tailored for each patient. We successfully employed a combination of available minimally invasive techniques to treat a patient who was not ideally suited to any of the individual strategies.

Abstract No. 160: Coupling bifurcated stent-graft against anatomic limitations for EVAR

Anatomic limitations such as conical shape, over 60° angulation of the proximal neck of the infrarenal abdominal aortic aneurysm and tortuosity of the distal limb of iliac arteries are the factors apparently influencing both technical and clinical success of the endovascular aneurysm repair (EVAR) for the treatment of infrarenal abdominal aortic aneurysm. The purpose of this study is to present the feasibility and efficacy of the coupling bifurcated stent-graft against such anatomic limitations. From July 2006 to April 2009, coupling method of percutaneous bifurcated stent-graft (main body, Zenith or Talent stent-graft for suprarenal fixation; bilateral limbs, Excluder limb stent-graft to adapt tortuous iliac arteries) for EVAR were performed in 19 patients [M:F=16:3, age range 62–87 years (mean, 73.3)] with infrarenal abdominal aortic aneurysm which all of them had conical shape and over 60° angulation of the proximal neck, and tortuosity of the iliac arteries. Technical success was achieved in all 19 patients. No periprocedural mortality. Eighteen patients (one follow-up loss) were followed-up regularly by means of helical CT scan for 1–32 (mean, 11.8) months. Proximal type I endoleak occurred in two patients, hence the clinical success was achieved in 16 of 18 patients (88.9%) who were followed-up. Complete exclusion without any type of endoleak was achieved in 13 patients. There were three patients with type II endoleak, one treated with glue and coil embolization and two are undergoing follow-up. None of patients showed aggravation of blood pressure or impairment of renal function. Even in patients with anatomic limitations included in this study, the coupling method of bifurcated stent-graft was technically feasible and achieved high clinical success rate. Long-term follow-up data need to be obtained.

Long-term results of Talent endografts for endovascular abdominal aortic aneurysm repair

Since the introduction of endovascular aneurysm repair (EVAR), long-term follow-up studies reporting single-device results are scarce. In this study, we focus on EVAR repair with the Talent stent graft (Medtronic, Santa Rosa, Calif). Between July 2000 and December 2007, 365 patients underwent elective EVAR with a Talent device. Patient data were gathered prospectively and evaluated retrospectively. By American Society of Anesthesiologists category, 74% were categories III and IV. Postoperative computed tomography (CT) scanning was performed before discharge, at 3, 12 months, and yearly thereafter. Data are presented according to reporting standards for EVAR. The mean proximal aortic neck diameter was 27 mm (range, 16-36 mm), with a neck length <15 mm in 31% (data available for 193 patients). Deployment of endografts was successful in 361 of 365 patients (99%). Initially, conversion to laparotomy was necessary in four patients. Primary technical success determined by results from computed tomography (CT) scans before discharge was achieved in 333 patients (91%). Proximal type I endoleaks were present in 28 patients (8%) during follow-up, and 14 of these patients needed additional treatment for type I endoleak. The 30-day mortality for the whole Talent group was 1.1% (4 of 365). Follow-up to 84 months is reported for 24 patients. During follow-up, 122 (33%) patients died; in nine, death was abdominal aortic aneurysm (AAA)-related (including 30-day mortality). Kaplan-Meier estimates revealed primary clinical success rates of 98% at 1 year, 93% at 2 years, 88% at 3 years, 79% at 4 years, 64% at 5 years, 51% at 6 years, and 48% at 7 years. Secondary interventions were performed in 73 of 365 patients (20%). Ten conversions for failed endografts were performed. Life-table yearly risk for AAA-related reintervention was 6%, yearly risk for conversion to open repair was 1.1%, yearly risk for total mortality was 8.9%, and yearly risk for AAA-related mortality was 0.8%. Initially, technical success of endovascular aneurysm repair (EVAR) using the Talent endograft is high, with acceptable 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.

Early Outcome of Endovascular Treatment of Acute Traumatic Aortic Injuries: The Talent Thoracic Retrospective Registry

Acute traumatic injury of the thoracic aorta (TAI) is a life-threatening complication in patients who sustain deceleration or crush injuries. This study was conducted to examine the results in patients who underwent endovascular repair with the Talent (Medtronic/AVE, Santa Rosa, CA) thoracic stent graft for acute traumatic injury. Out of 457 consecutive endograft patients, 41 (9%) were treated for traumatic aortic conditions. There were 36 males with a mean age of 36 +/- 14 years. Mean aortic diameter at the time of intervention was 34 mm +/- 9 (range, 20 to 70 mm). The mean length of covered aorta was 106 mm (range, 5 to 130 mm) with only one stent graft used in 98% (40) of all cases. Median follow-up period for hospital survivors was 13 months (1.0 to 69.0 months). Stent graft implantation was technically successful in all cases (100%). One patient died during hospitalization, yielding an overall in-hospital mortality rate of 2.4%. Procedural-related paraplegia was zero and a primary endoleak was observed in 1 patient. Postoperative complications occurred in 4 patients (3 respiratory failures, 1 multiorgan failure). No patient required conversion to open surgical repair. The treatment of acute traumatic injuries of the descending thoracic aorta with the Talent stent graft is a feasible and safe technique; it provides low morbidity and mortality rates in the early postoperative period, and early results are encouraging. However, long-term studies are worthwhile to evaluate the effectiveness and the durability of this procedure.

A 10-Year Single-Center Prospective Study of Endovascular Abdominal Aortic Aneurysm Repair With the Talent Stent-Graft

To report a 10-year prospective study of patients submitted to endovascular treatment for infrarenal abdominal aortic aneurysms (AAA). Between June 1997 and June 2007, 337 patients (284 men; mean age 72.5+/-7.4 years, range 52-89) with AAA underwent endovascular aneurysm treatment (EVAR) with implantation of Talent stent-grafts. The mean AAA diameter was 59.0+/-14.4 mm. All patients were clinically followed using computed tomography in the immediate post surgery period (15-30 days), after 6 months, and yearly thereafter. Plain abdominal radiography was performed yearly to assess the metallic components of the stent-grafts. Data concerning endoleaks, secondary procedures, and aneurysm diameter behavior were evaluated. Survival was evaluated using Kaplan-Meier estimates. Endoprosthesis implantations were successful in 99.1% (334/337). There were 2 surgical conversions, and the delivery system could not be inserted in 1 female patient. The perioperative mortality was 3.9% (n = 13). Nineteen (5.7%) aneurysms showed endoleaks during the first 30 days (6 type I and 13 type II); 5 type I and 3 type II endoleaks were repaired (secondary clinical success of 92.6%). Another 15 late endoleaks were detected (4 type I, 5 type II, 3 type III, 1 type IV, 2 endotension), for a total of 34 (10.2%) endoleaks. Follow-up (mean 58.7 months, range 12-120) was available in 273 (81.0%) patients. During this time, there were 2 (0.7%) aneurysm ruptures, 1 due to type III endoleak and the other to endotension. Over the course of the study, 75 patients died; the estimated survival rates by the Kaplan-Meyer analysis were 67.3% after 5 years and 54.2% after 7 years. The mean AAA diameter decreased to 45.7+/-18.4 mm (p<0.001 versus mean postoperative diameter) at 60 months and to 37.8+/-15.0 mm at 120 months (p<0.019). Endovascular aneurysm treatment with the Talent stent-graft has proven to be effective in the prevention of AAA rupture into the long term.

The Association between Iliac Fixation and Proximal Stent-graft Migration during EVAR Follow-up: Mid-term Results of 154 Talent Devices

This study investigated the importance of iliac fixation to secure endograft fixation. Computed tomography (CT) scans of patients who underwent endovascular aneurysm repair with an endoprosthesis of great columnar strength (Talent stent graft) were analysed retrospectively. Patients were enrolled consecutively between June 2000 and January 2007 and prospectively followed up with serial CT imaging. The superior mesenteric artery was used as a reference point to determine endograft migration (centerline endograft displacement of >or=10mm). Proximal and distal fixation lengths were defined as the length of the endograft that was in full apposition to the aortic neck or common iliac arteries, respectively. Proximal endograft migration occurred in 32 of 154 patients (21%) at a follow-up duration of 32+/-14 months; 13 migrations required treatment (8%). Migration was more frequent in patients treated with aorto-uniiliac devices than bifurcation devices (p<0.008). The migrator and non-migrator groups had similar demographic and abdominal aortic aneurysm (AAA) characteristics. The migrator group had significantly shorter proximal (30+/-12 mm vs. 41+/-13 mm, P<0.001) and distal endograft fixation lengths (31+/-18 mm vs. 47+/-15 mm, P<0.001). By multivariate regression analysis, proximal and distal endograft fixations were significant predictors for endograft migration at follow-up (P<0.001). Iliac endograft fixation, along with proximal fixation, is a significant predictor for endograft migration.

Short-term conversion to open surgery after endovascular stent-grafting of the thoracic aorta: The Talent thoracic registry

Predictors of late conversion to conventional surgery after thoracic endovascular stent-graft placement are currently unknown. We analyzed data from 422 of 457 consecutive patients who underwent endovascular thoracic repair with the Medtronic Talent thoracic stent-graft (Medtronic/AVE, Santa Rosa, Calif). Of these, 16 patients (3.8%) required late conversion to open surgery during a median follow-up interval of 17 months (range 7-33 months). Six of these patients had undergone previous aortic surgery, 3 patients had previous cardiac surgery, and 5 patients had Marfan syndrome. In patients with late conversion, indications for primary stent-graft placement were dissection in 10 patients, degenerative aneurysm in 5 patients, and penetrating ulcer in 1 patient. By multivariable Cox analysis, Marfan syndrome (adjusted hazard ratio 9.97, P = .008), type I endoleak (adjusted hazard ratio 3.99, P = .012), the use of more than 1 stent-graft (adjusted hazard ratio 3.89, P = .018), and procedural complications (adjusted hazard ratio 17.50, P = .003) were independent predictors of late conversion. Endovascular treatment for thoracic aortic disease with the Talent stent-graft is associated with a relatively low rate of late conversion to conventional surgery. Better results may be achieved by excluding patients with Marfan syndrome for such a procedure and early aggressive treatment of early type I endoleaks.

Endovascular Aortic Aneurysm Repair with the Talent Stent-Graft: Outcomes in Patients with Large Iliac Arteries

The purpose of this study is to report outcomes following endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA) in patients with ectatic common iliac arteries (CIAs). Of 117 AAA patients treated by EVAR between 1998 and 2005, 87 (74%) had CIAs diameters <18 mm and 30 (26%) patients had one or more CIA diameters >18 but <25 mm. All patients were treated with Talent stent-grafts, 114 bifurcated and 3 AUI devices. Departmental databases and patient records were reviewed to assess outcomes. Technical success, iliac-related outcome, and iliac-related reintervention (IRSI) were analyzed. Patients with EVAR extending into the external iliac artery were excluded. Median (range) follow-up for the study group was 24 (1-84) months. Initial technical success was 98% for CIAs <18 mm and 100% for CIAs >/=18 mm (p = 0.551). There were three distal type I endoleaks (two in the ectatic group) and six iliac limb occlusions (one in an ectatic patient); there were no statistically significant differences between groups (p = 0.4). There were nine IRSIs (three stent-graft extensions, six femorofemoral crossover grafts); three of these patients had one or both CIAs >/=18 mm (p = 0.232). One-year freedom from IRSI was 92% +/- 3% and 84% +/- 9% for the <18-mm and >/=18-mm CIA groups, respectively (p = 0.232). We conclude that the treatment of AAA by EVAR in patients with CIAs 18-24 mm appears to be safe and effective, however, it may be associated with more frequent reinterventions.

Single-Center Experience With the Talent LPS Endograft in Patients With at Least 5 Years of Follow-up

To evaluate long-term results in patients undergoing elective endovascular aneurysm repair (EVAR) using the Talent LPS endograft to treat abdominal aortic aneurysm (AAA). Fifty patients (49 men; median age 72 years, range 54-89) were treated electively between 1997 and 2001 with the Talent LPS endograft chosen for various anatomical reasons, including short (< or =15 mm) aortic neck (32.5%), iliac ectasia (> or =18 mm) in at least 1 iliac artery (32%), angulated (30 degrees -60 degrees ) aortic neck (16%), large (> or =28 mm) aortic neck (6%), and tapered, reversed tapered, or bulging aortic neck (14%). A quarter of patients were preoperatively classified as unfit for AAA open repair, and 58% were high risk (ASA III or IV). The primary endpoints were immediate success, aneurysm-related and non-aneurysm-related mortality, secondary interventions, graft-related complications, graft migration (> or =5 mm), and structural failure. Implantation success was achieved in 96% (48/50). Four (8%) patients died within 30 days; in follow-up, the mortality rate was 51% over a mean 47.7+/-27.4 months (minimum of 5 years). Aneurysm-related mortality was 12% (6/50); 3 (6%) patients were converted. The overall reintervention rate was 16% (8/50). There were 9 (18%) endoleaks in 8 patients: 4 type I (2 proximal, 2 distal), 3 type II, and 2 type III. The migration rate was 4% (1 ruptured AAA, 1 endoleak). Individual cases of graft kinking and stent fracture occurred in this series. Despite the small population, trends in our results suggest that the Talent stent-graft performs well over the long term. Surveillance, especially with regard to migration and graft integrity, remains of great importance.

No Difference in Medium-Term Outcome Between Zenith and Talent Stent-Grafts in Endovascular Aneurysm Repair

Many devices are available for endovascular aneurysm repair (EVAR). Our aim was to analyze morphological effects of the Zenith and Talent systems. Patients included underwent EVAR from June 1999 to June 2005 using a Zenith or Talent stent-graft, with computed tomography follow-up. Aortic dimensions over time and clinical outcome were analyzed. Twenty-nine patients with Zenith stent-grafts and 33 with Talent devices were included. Mean preoperative age was similar (75.5+/-6.0 years vs 74.2+/-6.7 years; P=.29). Preoperative neck length was longer in the Zenith group (29.9+/-15.2 mm vs 25.5 +/- 10.8 mm; P=.10), and stent-graft oversizing was greater in the Talent patients (20.2%+/-7.9% vs 23.0% +/- 11.3%). There was proximal aortic dilatation and aneurysm sac shrinkage in each group. Complication rates were comparable, with 83% of both groups free from 10-mm migration. Although device designs differ, there is no difference in clinical outcome between Zenith and Talent stent-grafts. Migration rates were not influenced by suprarenal fixation.