Device-specific Outcomes Following Endovascular Aortic Aneurysm Repair

Abstract 

Objective

To compare aneurysm morphology, initial outcomes and mid-term results in patients receiving Talent or Zenith grafts for elective endovascular aneurysm repair (EVR).

Methods

Over a 6-year time period ending in 2007, 286 patients underwent elective EVR of infra-renal abdominal aortic aneurysms using Talent or Zenith devices. Patient demographics, aneurysm morphology and initial outcomes (primary-assisted technical success rates, 30-day limb occlusion, re-intervention and mortality) were compared using chi-squared tests or Student's t-tests. Kaplan–Meier curves were calculated to compare cumulative rates of freedom from type I or III endoleak, re-intervention, endograft patency and overall survival over mid-term follow-up.

Results

Adverse aneurysm morphology was more common in patients receiving Zenith stent grafts, with a greater proportion of shorter neck lengths (<10mm, 12.9% vs 0%; p≤0.001) and severe neck angulation (>60°, 25.0% vs 10.3%; p=0.002). Equivalent primary-assisted technical success rates were achieved with both Talent and Zenith grafts (94.0% vs 96.1%; p=0.41). A significant number of adjunctive procedures were required in both groups to obtain a proximal endograft seal, with relatively more procedures performed in the Talent group (28.6% vs 12.4%; p=0.003). Early outcomes were similar for 30-day re-intervention (5.3% vs 3.9%; p=0.91), 30-day limb occlusion (1.5% vs 2.6%; p=0.51), 30-day morbidity (6.8% vs 11.8%; p=0.15) and 30-day mortality (4.5% vs 3.9%; p=0.80).

The cumulative incidence of freedom from re-intervention was 88.3±2.9%, 86.1±3.3% and 84.1±3.9% at 1, 2 and 3 years respectively. There were no significant differences between Talent and Zenith groups for re-intervention, type I or III endoleak or limb occlusion rates over the same time period. Overall patient survival was 88.4±2.85% at 1 year, 83.7±4.0% at 2 years and 78.9±5.5% at 3 years.

Conclusions

Equivalent primary-assisted technical success rates can be achieved using either Talent or Zenith endografts for endovascular aneurysm repair, but operating teams should be prepared to perform additional adjunctive procedures to obtain a primary proximal seal with either stent. The Zenith endograft performed well in the context of less favourable pre-operative aneurysm morphology. Both Talent and Zenith endografts appeared equally durable in the medium term.

Keywords: Abdominal aortic aneurysm, Endovascular aneurysm repair, EVR, Graft manufacturer