Device-specific Outcomes Following Endovascular Aortic Aneurysm Repair

ObjectiveTo compare aneurysm morphology, initial outcomes and mid-term results in patients receiving Talent or Zenith grafts for elective endovascular aneurysm repair (EVR).MethodsOver 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.ResultsAdverse aneurysm morphology was more common in patients receiving Zenith stent grafts, with a greater proportion of shorter neck lengths (<10 mm, 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.ConclusionsEquivalent 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.