Comparison of midterm results for the Talent and Endurant stent graft

Mannetje, Yannick W. ‘t; Cuypers, Philippe W.M.; Saleem, Ben R.; Bode, A.S.; Teijink, Joep A.W.; Sambeek, Marc R.H.M. van

doi:10.1016/j.jvs.2017.01.022

Cited by 16 publications

(9 citation statements)

References 26 publications

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“…One acute thrombotic limb ischemia occurred 15 months after the procedure. In a recently published study, 13 2 generations of Medtronic endografts were compared in 221 patients (131 Endurant and 90 Talent) with an overall mean follow-up of 61 months. With the new Endurant endograft design, the number of complications at the level of the aortic neck was reduced, but the number of iliac interventions increased.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Treatment of Limb Occlusion of the Anaconda Endograft After Endovascular Aneurysm Repair

et al. 2018

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To evaluate the incidence and treatment of limb occlusions of the second-and third-generation Anaconda endografts. Methods: A single-center retrospective study was conducted involving 317 consecutive patients (mean age 76 years; 289 men) who underwent endovascular aneurysm repair for elective asymptomatic, symptomatic intact, and ruptured infrarenal abdominal aortic aneurysm with 2 versions of the Anaconda device. From September 2003 to July 2011, the second-generation device was used in 189 patients (mean age 77 years; 169 men) and from July 2011 to September 2015, the third-generation device was implanted in 128 patients (mean age 75 years; 120 men). The rates of limb occlusion were compared between groups and according to compliance with the instructions for use (IFU); predictors were sought in multivariate analysis. The results of the latter are given as the hazard ratio (HR) and 95% confidence interval (CI). Results: Kaplan-Meier freedom of occlusion estimates for second-and third-generation devices, respectively, was 96.6% and 95.0% at 1 year, 89.9% and 95.0% at 2 years, and 86.5% and 88.6% at 5 years. There was no significant difference in overall occlusion rate between the second-generation devices (p=0.332) or with regard to use within the IFU (p=0.827); however, there was a clinically relevant decrease in the occlusion rate for elective patients treated with the third-generation device (6.4% vs 13.1%, p=0.077). There was an increase in the occlusion rate when the iliac limb diameter was ≤13 mm. In multivariate analysis, the only independent predictor of limb occlusion was a small distal prosthesis diameter (HR 0.732, 95% CI 0.63 to 0.86, p<0.001). Symptomatic nonruptured and ruptured abdominal aortic aneurysm (AAA) interventions had an almost 2-fold increased risk of occlusion (HR 1.95, 95% CI 0.93 to 4.11, p=0.078), though this did not reach statistical significance. Conclusion: The Anaconda design has proven effectiveness in AAA exclusion in daily practice inside the IFU. However, efforts could be made to further reduce the limb occlusion rate.

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Section: Discussionmentioning

confidence: 99%

Incidence and Treatment of Limb Occlusion of the Anaconda Endograft After Endovascular Aneurysm Repair

et al. 2018

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“…20 Whereas in the study from Broos et al the Talent (Medtronic, Santa Rosa, Calif) was used in 63.3% of r-EVAR cases (vs 30.8% of el-EVAR procedures) in our population the Endurant (Medtronic) was most commonly implanted device for r-EVAR. A comparative study from t'Mannetje et al 21 found that the Talent was associated to an increased risk of proximal neck complications (odds ratio, 6.73; 95% CI, 1.65-27.4) when compared with the Endurant endoprosthesis as that device lacks active fixating such as hooks and barbs. These findings may also explain why r-EVAR patients had more type I and III endoleaks in the study by Broos et al In our study, patients who died in hospital or were intraoperatively converted to open repair were excluded, which probably leaves out from the study a proportion of patients with a significantly hostile anatomy.…”

Section: Journal Of Vascular Surgerymentioning

confidence: 99%

Comparison of midterm results of endovascular aneurysm repair for ruptured and elective abdominal aortic aneurysms

Oliveira‐Pinto

Soares-Ferreira

Oliveira

et al. 2020

Journal of Vascular Surgery

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Objective: Endovascular aneurysm repair (EVAR) became an increasingly preferred modality for abdominal aortic aneurysm (AAA) repair both in elective AAA repair (el-EVAR) and EVAR of a ruptured AAA (r-EVAR) setting. Ruptured AAAs usually have more hostile anatomies and less time for planning. Consequently, more complications may arise after r-EVAR. The purpose of this study was to compare mi-term outcomes between r-EVAR and el-EVAR.Methods: A retrospective cohort analysis of patients undergoing EVAR from 2000 to 2015 at a tertiary institution was performed. Patients with previous aortic surgery, nonatherosclerotic AAA and isolated iliac aneurysms were excluded. In-hospital casualties or patients who were intraoperatively converted to open repair were also excluded. For the midterm outcome analysis, only patients with at least two postoperative examinations (a 30-day computed tomography scan and a second postoperative examination performed 6 months or later) were considered. The primary end point was freedom from aneurysm-related complications (a composite of type I or III endoleak, aneurysm sac growth, migration of more than 5 mm, device integrity failure, AAA-related death, late postimplant rupture, or AAA-related secondary intervention). Freedom from secondary interventions, neck-related events (defined as a composite of type IA endoleak, migration of more than 5 mm, or preemptive neck-related secondary intervention) and late survival were secondary end points. The impact of device instructions for use (IFU) compliance on neck events was also assessed. Results:The study included 565 patients (65 r-EVAR and 500 el-EVAR). Eighty-two patients were treated outside proximal neck IFU, 13 in the r-EVAR group (21.3%) and 69 (14.5%) in the el-EVAR (P ¼ .16). During the index hospitalization, there were more complications (12.3% vs 3.2%; P ¼ .001) and reinterventions (12.3% vs 2.8%; P < .001) in the r-EVAR group. After discharge, median clinical follow-up time was 4.3 years (interquartile range, 2.1-7.0 years) without differences between both groups. Five-year freedom from AAA-related complications was 53.9% in the r-EVAR group and 65.4% in the el-EVAR (P ¼ .21). In multivariable analysis the r-EVAR group was not at increased risk for late complications (hazard ratio

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“…Still, because most of them compare different generation endografts, used in different periods, and even some devices withdrawn from the market, these are of limited value to current EVAR practices. [5][6][7] The Endurant (Medtronic Vascular, Inc, Minneapolis, Minn) and the Excluder (W. L. Gore & Associates, Flagstaff, Ariz) are two commercially available late-generation endoprostheses. Each device has different accepted thresholds for specific morphologic features expressed in their instructions for use (IFU), particularly regarding the infrarenal neck.…”

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confidence: 99%

Long-term results after standard endovascular aneurysm repair with the Endurant and Excluder stent grafts

Oliveira‐Pinto

Oliveira

Gonçalves

et al. 2020

Journal of Vascular Surgery

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Objective: Many endografts are currently available for standard endovascular repair of infrarenal abdominal aortic aneurysms. Comparison of long-term outcomes between devices might aid in this decision process, but comparative data are scarce. The purpose of this study was to report long-term clinical outcomes of two commercially available endoprosthesis, the Endurant (Medtronic Vascular, Inc, Minneapolis, Minn) and the Excluder (W. L. Gore & Associates, Flagstaff, Ariz) stent grafts.Methods: Patients undergoing standard endovascular repair from July 2004 to December 2011 in a single institution with the Endurant or the Low-Porosity Excluder endografts were eligible. Only patients treated for intact degenerative abdominal infrarenal aneurysms were included. All measurements were performed on center-lumen line reconstructions obtained on dedicated software. The primary end point was primary clinical success, defined as clinical success without the need for an additional or secondary surgical or endovascular procedure. Neck-related events (a composite of type IA endoleak, neck-related secondary intervention, or migration of >5 mm), neck morphology changes, renal function, and overall survival were secondary end points.Results: The study included 277 patients (156 Endurants; 121 Excluders). The median follow-up was 5.8 years (range, 0.1-12.4 years) and did not differ between groups (P ¼ .18). Patients treated with the Endurant stent graft had wider (neck diameter of >28 mm, 27.3% vs 1.7% [P < .001]; neck diameter of 27 mm, [interquartile range (IQR), 24-29 mm] for Endurant and 24 mm [IQR, 22-25 mm] for Excluder; P < .001) and more angulated necks (b-angle of >60 , 26.7% vs 12.5%; P ¼ .004). Oversizing was greater in the Endurant group (16% [IQR, 12%-22%] vs 13% [IQR, 8%-17%], respectively; P < .001). Patients were treated outside device instructions for use regarding proximal neck: 16.7% in the Endurant and 17.3% in the Excluder group (P ¼ .720). The 7-year primary clinical success was 54.7% for the Endurant and 58.1% for the Excluder groups (P ¼ .53). Freedom from neck-related events at 7 years was 76.7% for the Endurant and 78.8% for Excluder group (P ¼ .94). The Endurant stent graft (hazard ratio [HR], 2.7; 95% confidence interval [CI], 1.3-5.8; P ¼ .009) was an independent predictor of significant renal function decline. Neck dilatation was greater in Endurant-implanted patients (13% [95% CI, 2%-22%] vs 4% [95% CI, 0%-10%]; P < .001). Overall survival at 7 years was 61.4% in the Endurant and 50.3% (n ¼ 50; standard error, 0.047) in the Excluder group (P ¼ .39).Conclusions: This study reveals that durable and sustainable results can be obtained with either of these late generation devices. This finding suggests that careful planning and a tailored device selection taking into account the patient's anatomy are more relevant determinants than the graft model itself to obtain clinical success. The Endurant endoprosthesis seems to be associated with a higher rate of neck dilatation and faster decrease in the estimate...

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Comparison of midterm results for the Talent and Endurant stent graft

Abstract: Evolution 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.

Cited by 16 publications

References 26 publications

Incidence and Treatment of Limb Occlusion of the Anaconda Endograft After Endovascular Aneurysm Repair

Incidence and Treatment of Limb Occlusion of the Anaconda Endograft After Endovascular Aneurysm Repair

Comparison of midterm results of endovascular aneurysm repair for ruptured and elective abdominal aortic aneurysms

Long-term results after standard endovascular aneurysm repair with the Endurant and Excluder stent grafts

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