Long-Term EVAR Results Published for Talent Endograft

February 14, 2011—Long-term results of the Talent stent graft (Medtronic, Inc., Minneapolis, MN) for endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs) have been published by Bart A. N. Verhoeven, MD, et al in the Journal of Vascular Surgery (2011;53:293–298).

The study was composed of 365 patients who underwent elective EVAR with a Talent device between July 2000 and December 2007. Patient data were gathered prospectively and evaluated retrospectively. As assessed by American Society of Anesthesiologists category, 74% of patients were categories III and IV. Postoperative computed tomography scanning was performed before discharge, at 3 and 12 months, and yearly thereafter. The data were presented according to reporting standards for EVAR.

The investigators reported that 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, as determined by results from computed tomography scans before discharge, was achieved in 333 patients (91%). Proximal type I endoleak was present in 28 patients (8%) during follow-up, and 14 of these patients needed additional treatment for the endoleak. The 30-day mortality rate for the entire Talent group was 1.1% (4 of 365 patients died).

As detailed in the Journal of Vascular Surgery, follow-up to 84 months is reported for 24 patients. During follow-up, 122 patients (33%) died; in nine patients, death was 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. The 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%.

The investigators concluded that, initially, technical success of EVAR using the Talent endograft is high with acceptable yearly risk for AAA-related mortality and conversion. However, a substantial amount of reinterventions (mainly endovascular) are necessary during long-term follow-up to achieve these results.