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Objectives: To report the long-term results of a single-center consecutive series of patients with infrarenal abdominal aortic aneurysms (AAA) treated using the Talent Aortic Stent Graft System (Medtronic, Santa Rosa, CA).
Methods: Between November 1998 and November 2008, 50 patients (43 men, 7 women, age 74 ± 7.9 years) with AAA underwent endoluminal repair with Talent stent grafts. The mean AAA size was 5.8 ± 0.84cm. Patient follow-up evaluation included clinical exam, computed tomographic angiography, renal duplex ultrasound, and serum creatinine concentration. Primary outcome was rupture-free survival. Secondary outcomes included renal function, renal artery patency, incidence of endoleak, and rates of secondary intervention.
Results: Successful graft implantation was accomplished in 49 of 50 patients (98%). Median follow up was 80 months (43, 106). Thirty-day mortality was 0%, with overall mortality rate of 73.5% at time of follow up. Mean time of death from operation was 62 ± 36 months. One patient experienced aneurysm rupture 67 months postoperatively and was successfully treated with open repair. No patient died because of known aneurysm rupture. In patients with normal renal function preoperatively (defined as serum creatinine ≤1.4mg/dL), only 5 patients (10.2%) had elevations in serum creatinine values to above normal range. Three patients (6.1%) had worsening of pre-existing renal disease as defined by >20% increase in their baseline creatinine. Development of severe renal artery stenosis (defined as renal-aortic velocity ratio >3.6 on duplex ultrasound) occurred in 7 patients (14.3%), including one renal artery occlusion. Renal artery stenosis was not associated with a significant change in creatinine levels. Endoleaks occurred in 26.4% of patients (n=13). 17 secondary interventions were required in 12 patients (24.5%) because of endoleak (n=7), graft migration (n=1), device integrity failure (n=1), aneurysm rupture (n=1), and thrombosis (n=2).
Conclusion: Long-term follow up of Talent endovascular stent grafts shows this system to be durable and safe with a low rate of graft failure. Renal function is well preserved over the long term, and secondary intervention rates are comparable to previous published reports. In patients who are not candidates for traditional open repair of their infrarenal AAA the Talent endovascular graft appears to be a reliable treatment option.