CardioVascular and Interventional Radiology

, Volume 32, Issue 5, pp 906–917 | Cite as

Ten-Year Follow-Up of Endovascular Aneurysm Treatment with Talent Stent-Grafts

  • Michael B. Pitton
  • Tobias Scheschkowski
  • Markus Ring
  • Sascha Herber
  • Katja Oberholzer
  • Annegret Leicher-Düber
  • Achim Neufang
  • Walther Schmiedt
  • Christoph Düber
Clinical Investigation

Abstract

The purpose of this study was to evaluate the clinical results, complications, and secondary interventions during long-term follow-up after endovascular aneurysm repair (EVAR) and to investigate the impact of endoleak sizes on aneurysm shrinkage. From 1997 to March 2007, 127 patients (12 female, 115 male; age, 73.0 ± 7.2 years) with abdominal aortic aneurysms were treated with Talent stent-grafts. Follow-up included clinical visits, contrast-enhanced MDCT, and radiographs at 3, 6, and 12 months and then annually. Results were analyzed with respect to clinical outcome, secondary interventions, endoleak rate and management, and change in aneurysm size. There was no need for primary conversion surgery. Thirty-day mortality was 1.6% (two myocardial infarctions). Procedure-related morbidity was 2.4% (paraplegia, partial infarction of one kidney, and inguinal bleeding requiring surgery). Mean follow-up was 47.7 ± 34.2 months (range, 0–123 months). Thirty-nine patients died during follow-up; three of the deaths were related to aneurysm (aneurysm rupture due to endoleak, n = 1; secondary surgical reintervention n = 2). During follow-up, a total of 29 secondary procedures were performed in 19 patients, including 14 percutaneous procedures (10 patients) and 15 surgical procedures (12 patients), including 4 cases with late conversion to open aortic repair (stent-graft infection, n = 1; migration, endoleak, or endotension, n = 3). Overall mean survival was 84.5 ± 4.7 months. Mean survival and freedom from any event was 66.7 ± 4.5 months. MRI depicted significantly more endoleaks compared to MDCT (23.5% vs. 14.3%; P < 0.01). Patients in whom all aneurysm side branches were occluded prior to stent-grafting showed a significantly reduced incidence of large endoleaks. Endoleaks >10% of the aneurysm area were associated with reduced aneurysm shrinkage compared to no endoleaks or <10% endoleaks (Δ at 3 years, −1.8% vs. −12.0%; P < 0.05). In conclusion, endovascular aneurysm treatment with Talent stent-grafts demonstrated encouraging long-term results with moderate secondary intervention rates. Primary occlusion of all aortic side branches reduced the incidence of large endoleaks. Large endoleaks significantly impaired aneurysm shrinkage, whereas small endoleaks did not.

Keywords

Abdominal aortic aneurysm Endovascular treatment 

References

  1. 1.
    Dubost C, Allary M, Oeconomos N (1952) Resection of an aneurysm of the abdominal aorta: reestablishment of continuity by preserved human arterial graft, with results after 5 months. Arch Surg 64:405–408Google Scholar
  2. 2.
    DeBakey ME, Cooley DA (1953) Surgical treatment of aneurysm of the abdominal aorta by resection and restoration of continuity with homograft. Surg Gynecol Obstet 97:257Google Scholar
  3. 3.
    Ernst CB (1993) Abdominal aortic aneurysm. N Engl J Med 328:1167–1172PubMedCrossRefGoogle Scholar
  4. 4.
    Parodi JC, Palmaz JC, Barone HD (1991) Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 5:491–499PubMedCrossRefGoogle Scholar
  5. 5.
    Parodi JC (1995) Endovascular repair of abdominal aortic aneurysms and other arterial lesions. J Vasc Surg 21:549–557PubMedCrossRefGoogle Scholar
  6. 6.
    Hinchliffe RJ, Ivancev K (2008) Endovascular aneurysm repair: current and future status. Cardiovasc Interv Radiol 31:451–459CrossRefGoogle Scholar
  7. 7.
    Kubin K, Sodeck GH, Teufelsbauer H, Nowatschka B, Kretschmer G, Lammer J, Schoder M (2008) Endovascular therapy of ruptured abdominal aortic aneurysm: mid- and long-term results. Cardiovasc Interv Radiol 31:496–503CrossRefGoogle Scholar
  8. 8.
    Teufelsbauer H, Prusa AM, Wolff K, Polterauer P, Nanobashvili J, Prager M, Hölzenbein T, Thurnher S, Lammer J, Schemper M, Kretschmer G, Huk I (2002) Endovascular stent grafting versus open surgical operation in patients with infrarenal aortic aneurysms. Circulation 106:782–787PubMedCrossRefGoogle Scholar
  9. 9.
    Schermerhorn ML, O’Malley AJ, Jhaveri A, Cotterill P, Pomposelli F, Landon BE (2008) Endovascular versus open repair of abdominal aortic aneurysms in the Medicare population. N Engl J Med 358:464–474PubMedCrossRefGoogle Scholar
  10. 10.
    Earls JP, Rofsky NM, DeCorato DR, Krinski GA, Wenreb JC (1996) Breath-hold single-dose gadolineum-enhanced three-dimensional MR aortography: usefulness of a timing examination and MR power injector. Radiology 201:705–710PubMedGoogle Scholar
  11. 11.
    White GH, May J, Waugh RC, Yu W (1998) Type I and Type II endoleaks. A more useful classification for reporting results of endoluminal AAA repair. J Endovasc Surg 5:189–191PubMedCrossRefGoogle Scholar
  12. 12.
    White GH, May J, Waugh RC, Yu W (1999) Type III and Type IV endoleak: toward a complete definition of blood flow in the sac after endoluminal AAA repair. J Endovasc Surg 6:305–307CrossRefGoogle Scholar
  13. 13.
    Blankensteijn JD, de Jong SECA, Prinssen M, van der Ham AC, Buth J, van Sterkenburg SMM, Verhagen HJM, Buskens E, Grobbee DE (2005) Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms. N Engl J Med 352:2398–2405PubMedCrossRefGoogle Scholar
  14. 14.
    Heller JA, Weinberg A, Arons R, Krishnasastry KV, Lyon RT, Deitch JS, Schulick AH, Bush HL Jr, Kent KC (2000) Two decades of abdominal aortic aneurysm repair: have we made any progress? J Vasc Surg 32:1091–1100PubMedCrossRefGoogle Scholar
  15. 15.
    Nowygrod R, Egorova N, Greco G et al (2006) Trends, complications, and mortality in peripheral vascular surgery. J Vasc Surg 43:205–216PubMedCrossRefGoogle Scholar
  16. 16.
    Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Tompson SG (2004) Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative operative mortality results: randomised controlled trial. Lancet 364:843–848PubMedCrossRefGoogle Scholar
  17. 17.
    Lee WA, Carter JW, Upchurch G, Seeger JM, Huber TS (2004) Perioperative outcomes after open and endovascular repair of intact abdominal aortic aneurysms in the United States during 2001. J Vasc Surg 39:491–496PubMedCrossRefGoogle Scholar
  18. 18.
    Prinssen M, Verhoeven EL, Buth J et al (2004) A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med 351:1607–1618PubMedCrossRefGoogle Scholar
  19. 19.
    Brown LC, Greenhalgh RM, Kwong GPS, Powell JT, Thompson SG, Wyatt MG (2007) Secondary interventions and mortality following endovascular aortic aneurysm repair: device-specific results from the UK EVAR trials. Eur J Vasc Endovasc Surg 34:281–290PubMedCrossRefGoogle Scholar
  20. 20.
    May J, White GH, Waugh R, Ly CN, Stephen MS, Jones MA, Harris JP (2001) Improved survival after endoluminal repair with second-generation prostheses compared with open repair in the treatment of abdominal aortic aneurysms: a 5-year concurrent comparison using life table method. J Vasc Surg 33(Suppl 2):21–26CrossRefGoogle Scholar
  21. 21.
    Chuter TA, Reilly LM, Faruqi RM, Kerlan RB, Sawhney R, Canto CJ, Laberge JM, Wilson MW, Gordon RL, Wall SD, Rapp J, Messina LM (2000) Endovascular aneuryms repair in high-risk patients. J Vasc Surg 31:122–133PubMedCrossRefGoogle Scholar
  22. 22.
    Chuter TA, Faruqi RM, Sawhney R, Reilly LM, Kerlan RB, Canto CJ, Lukaszewsicz GC, Laberge JM, Wilson MW, Gordon RL, Wall SD, Rapp J, Messina LM (2001) Endoleak after endovascular repair of abdominal aortic aneurysm. J Vasc Surg 34:98–105PubMedCrossRefGoogle Scholar
  23. 23.
    Torsello G, Osada N, Florek HJ, Horsch S, Kortmann H, Luska G, Scharrer-Pamler R, Schmiedt W, Umscheid T, Wozniak G, Talent AAA Retrospective Longterm Study Group (2006) Long-term outcome after talent endograft implantation for aneurysms of the abdominal aorta: a multicenter retrospective study. J Vasc Surg 43:277–284PubMedCrossRefGoogle Scholar
  24. 24.
    Blum U, Voshage G, Lammer J, Beyersdorf F, Tollner D, Kretschmer G, Spillner G, Polterauer P, Nagel G, Hölzenbein T (1997) Endoluminal stent-grafts for infrarenal abdominal aortic aneurysms. N Engl J Med 336:13–20PubMedCrossRefGoogle Scholar
  25. 25.
    Conners MS, Sternberg WC, Carter G, Tonnessen BH, Yoselevizt M, Money SR (2002) Secondary procedures after endovascular aortic aneurysm repair. J Vasc Surg 36:992–996CrossRefGoogle Scholar
  26. 26.
    Laheij RJF, Buth J, Harris PL, Moll FL, Stelter WJ, Verhoevenon ELG (2000) Need for secondary interventions after endovascular repair of abdominal aortic aneurysms. Intermediate-term follow-up results of a European collaborative registry (EUROSTAR). Br J Surg 87:1666–1673PubMedCrossRefGoogle Scholar
  27. 27.
    Cao P, Verzini F, Zannetti S, De Rango P, Parlani G, Lupattelli L, Maselli A (2002) Device migration after endoluminal abdominal aortic aneurysm repair: analysis of 113 cases with a minimum follow-up period of 2 years. J Vasc Surg 35:229–235PubMedCrossRefGoogle Scholar
  28. 28.
    Conners MS, Sternbergh WC, Carter G, Tonnessen BH, Yoselevitz M, Money SR (2002) Endograft migration one to four years after endovascular abdominal aortic aneurysm repair with the AneuRx device. A cautionary note. J Vasc Surg 36:476–484PubMedCrossRefGoogle Scholar
  29. 29.
    Pitton MB, Herber S, Schmiedt S, Neufang A, Thelen M (2005) MRI versus spiral CT for endoleak detection following endovascular aneurysm repair. Am J Roentgenol 185:1275–1281CrossRefGoogle Scholar
  30. 30.
    Gilling-Smith G, Brennan J, Harris P, Bakran A, Gould D, McWilliams R (1999) Endotension after endovascular aneurysm repair. Definition, classification, and strategies for surveillance and intervention. J Endovasc Surg 6:305–307PubMedCrossRefGoogle Scholar
  31. 31.
    Torsello GB, Klenk E, Kasprzak B, Umscheid T (1998) Rupture of abdominal aortic aneurysm previously treated by endovascular stentgraft. J Vasc Surg 28:184–187PubMedCrossRefGoogle Scholar
  32. 32.
    Broker HS, Foteh KI, Murphy EH, Davis CM, Calgett GP, Modrall JG, Buckley CJ, Arko FR (2008) Device specific aneurysm sac morphology after endovascular aneurysm repair: evaluation of contemporary graft materials. J Vasc Surg 47:702–706PubMedCrossRefGoogle Scholar
  33. 33.
    Golzarian J, Struyven J, Abada HT, Wery D, Dussaussois L, Madani A, Ferreira J, Dereume JP (1997) Endovascular aortic stent-grafts: transcatheter embolization of persistent perigraft leaks. Radiology 202:731–734PubMedGoogle Scholar
  34. 34.
    Pitton MB, Schmenger P, Düber C, Neufang A, Thelen M (2003) Systemic pulsatile pressure in type II endoleaks after stent grafting of experimental abdominal aortic aneurysms. Cardiovasc Interv Radiol 26:283–289CrossRefGoogle Scholar
  35. 35.
    Gould DA, McWilliams R, Edwards RD, Martin J, White D, Joekes E, Rowlands PC, Brennan J, Gilling-Smith G, Harris PL (2001) Aortic side branch embolization before endovascular aneurysm repair: incidence of Type II endoleaks. JVIR 12:337–341PubMedGoogle Scholar
  36. 36.
    Baum RA, Carpenter JP, Golden MA, Velazques OC, Clark TWI, Stavropoulous SW, Cope C, Fairman RM (2002) Treatment of type 2 endoleaks after endovascular repair of abdominal aortic aneurysms: comparison of transarterial and translumbar techniques. J Vasc Surg 35:23–29PubMedGoogle Scholar
  37. 37.
    Solis M, Ayerdi J, Babcock GA, Parra JR, McLafferty RB, Gruneiro LA, Ramsey DE, Hodgson KJ (2002) Mechanism of failure in the treatment of type II endoleaks with percutaneous coil embolization. J Vasc Surg 36:485–491PubMedCrossRefGoogle Scholar
  38. 38.
    Haulon S, Tyazi A, Willoteaux S, Koussa M, Lions C, Beregi J-P (2001) Embolization of type II endoleaks after aortic stent-graft implantation: technique and immediate results. J Vasc Surg 34:600–605PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2009

Authors and Affiliations

  • Michael B. Pitton
    • 1
  • Tobias Scheschkowski
    • 1
  • Markus Ring
    • 1
  • Sascha Herber
    • 1
  • Katja Oberholzer
    • 1
  • Annegret Leicher-Düber
    • 1
  • Achim Neufang
    • 2
  • Walther Schmiedt
    • 2
  • Christoph Düber
    • 1
  1. 1.Department of Diagnostic and Interventional RadiologyUniversity Hospital of Mainz, Johannes Gutenberg University of MainzMainzGermany
  2. 2.Department of Cardiovascular and Thoracic SurgeryUniversity Hospital of Mainz, Johannes Gutenberg University of MainzMainzGermany

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