Technical and Clinical Outcome of Talent versus Endurant Endografts for Endovascular Aortic Aneurysm Repair

The 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.From 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.The 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).Endurant endografts appear to have better technical and clinical outcome in patients with difficult aortoiliac anatomy, significantly reducing the occurrence of type 2 endoleaks

Kurzzeitergebnisse für Talent-Endoprothesen im Vergleich zu Endurant-Endoprothesen für die endovaskuläre Ausschaltung von abdominellen Aortenaneurysmen

Die technische Evolution von Endografts zur interventionellen Versorgung von infrarenalen abdominellen Aortenaneurysmen erlaubt eine stetige Erweiterung der Indikationsbreite, von der insbesondere Patienten mit schwierigen anatomischen Verhältnissen profitieren. In vorliegender Studie wurde die bereits etablierte Talent- Endoprothese mit dem Modell der nächsten Generation der Endurant-Endoprothese unter Berücksichtigung der aortoiliakalen Pathoanatomie verglichen. Im Zeitraum von 6/2007 - 12/2010 wurden 35 Patienten mit einer Talent- Endoprothese (33 Männer, Durchschnittsalter 75 Jahre) und 36 Patienten (34 Männer, Durchschnittsalter 78 Jahre) mit einer Endurant-Endoprothese versorgt. Die aortoiliakale Anatomie wurde detailliert anhand der präinterventionellen CTAngiographie evaluiert. Postinterventionell wurden die Angiographiedaten, die postinterventionelle CT-Angiographie und die elektronische Krankenakte der Patienten ausgewertet und die 30-Tages-Ergebnisse hinsichtlich technischem und klinischem Erfolg, der Endoleakrate und weiteren Komplikationen verglichen. In der Endurant-Gruppe wurden mehr Patienten mit einer anatomisch ungünstigeren Situation (Kinking der Beckenachsen, p = .017; kürzerem Aneurysmahals, p = .084) therapiert. Die primäre technische Erfolgsrate betrug in der Talent-Gruppe 91,4 % und in der Endurant-Gruppe 100 % (p = .115). Primäre Endoleaks Typ 1 traten in der Talent-Gruppe bei 5,7 % und in der Endurant-Gruppe bei 2,8 % der Patienten auf (p = .614). Ein Endoleak Typ 3 wurde ausschließlich in der Talent-Gruppe bei 2,9 % der Patienten nachgewiesen (p = .493). Endoleaks Typ 2 traten signifikant seltener in der Endurant-Gruppe mit 8,3 % im Vergleich zur Talent-Gruppe mit 28,6 % auf (p = .035). Major- und Minorkomplikationen unterschieden sich in beiden Gruppen nicht signifikant. Der assistierte primäre klinische Erfolg betrug 88,6 % für die Talent- Gruppe und 97,2 % für die Endurant-Gruppe (p = .199). Durch die Verwendung der Endurant-Endoprothese lassen sich unter ungünstigeren anatomischen Verhältnissen tendenziell bessere technische und klinische Erfolgsraten erzielen und das Auftreten von Endoleaks Typ 2 signifikant reduzieren.Objective: The technical evolution of endografts for the interventional management of infrarenal abdominal aortic aneurysm (AAA) has allowed a continuous expansion of indications, especially benefiting patients with difficult anatomy. This study compares the established Talent endograft with its successor, the Endurant endograft, taking individual aortioiliac pathoanatomy into account. Methods: From June 2007 through Dec. 2010, 35 patients with AAA were treated with a Talent endograft (33 men; mean age, 75 years) and 36 patients with an Endurant endograft (34 men; mean age, 78 years). Aortoiliac anatomy was evaluated in detail using preinterventional computed tomography angiography (CTA). Angiographic data, postinterventional CTA, and electronic patient files were analyzed and 30-day outcome compared with regard to technical and clinical success and complications such as endoleaks. Results: The Endurant group included more patients with unfavorable anatomy (kinking of pelvic arteries, P=.017; short aneurysm neck, P=.084). Primary technical success was 91.4% in the Talent group and 100% in the Endurant group (P=.115). Primary type 1 endoleaks occurred in 5.7% of the patients in the Talent group and in 2.8% of those in the Endurant group (P=.614). Type 3 endoleaks only occurred in the Talent group (2.9% of patients; P=.493). Type 2 endoleaks were significantly less common in the Endurant group compared with the Talent group (8.3% versus 28.6%; P=.035). Rates of major and minor complications were not significantly different between the two groups. Assisted primary clinical success was 88.6% in the Talent group and 97.2% in the Endurant group (P=.199). Conclusion: Endurant endografts tend to lead to better technical and clinical outcome in difficult anatomic conditions, significantly reducing the occurrence of type 2 endoleaks

CTA of an infrarenal AAA in a 74-year-old patient. A,

<p>VR of the long aneurysm with a short proximal neck. The aneurysm involves the aortic bifurcation, and there is marked angulation of the infrarenal portion (arrow indicates the left renal artery). Both common iliac arteries are markedly elongated. <b>B,</b> Lateral VR more clearly showing the elongation of the left common iliac artery and also severe kinking (arrowhead) at its origin as well as marked infrarenal angulation of the proximal neck (arrow indicates the left renal artery). <b>C,</b> Postinterventional VR indicating successful implantation of an Endurant stent graft and exclusion of AAA (arrow indicates the left renal artery).</p

Outcome at 30-day follow-up in the Talent versus Endurant group.

*<p>Classified as clinical failure. ^† Small embolic renal infarction at lower pole after the intervention without clinically relevant impairment of renal function.</p

CTA of a large infrarenal AAA in a 79-year-old patient.

<p><b>A,</b> Volume reconstruction (VR) of CTA with moderate calcification within the aneurysm sac and both common iliac arteries. <b>B,</b> VR performed 12 days after implantation of a Talent stent graft. <b>C,</b> Venous phase CTA reveals a type 2 endoleak (asterisk) posterior of the stent graft limb and a perfused lumbar artery on the left (arrow). <b>D,</b> More inferiorly, the site of entry of the lumbar artery into the aneurysm sac is seen (arrow).</p

Classification of endoleaks^*.

*<p>modified according to <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0038468#pone.0038468-Chaikof1" target="_blank">[11]</a>.</p

Basic data of study patients.

<p><i>PAOD</i> Peripheral artery occlusive disease.</p

Morphologic criteria for evaluating aortoiliac anatomy.

<p>Morphologic criteria for evaluating aortoiliac anatomy.</p