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Objectives: Results after endovascular aneurysm repair (EVAR) are improving with advancements in device technology. A lower profile may reduce immediate access vessel injury and postoperative wound complications which represent a significant source of morbidity.
Methods: Data was obtained from patients treated with the Endurant or Talent stent grafts during their respective pivotal trials. Outcomes including baseline characteristics, anatomical criteria , device profiles and access related complications were compared between the groups.
Results: Patients were treated with either Endurant (n=150) or Talent (n=166) endografts. Groups were matched in age (p=0.25), gender (p=0.16) and baseline characteristics with the exception of a higher incidence of diabetes (p=0.02) and CHF (p=0.01) for Endurant and PVD (p<0.001)for Talent. Anatomical criteria were matched in regards to aneurysm size, iliac tortuosity and iliac artery diameters (p=NS). Arterial injury during device insertion or removal was reduced in the Endurant group (n=4,2.7%) compared to the Talent group (n=14,8.4%)(p=0.03). Patients treated with the Endurant graft further had reduced EBL (184.9+/-167.9 vs. 335 +/- 282.4 cc, p<0.001) and need for transfusion (0 vs 18.2%, p<0.001). Overall, postoperative groin complications were also significantly lower in patients treated with the Endurant stent graft (n=26,17.3% vs n=45,27.1%, p=0.04). Specifically, patients treated with the Endurant had reduced incidence of postop hematomas and seromas (n=17,11.3%) compared to those treated with the Talent device (n=34,20.5%)(p=0.03). The rate of infections was similar (p=NS).
Conclusions: Low profile delivery systems can help to reduce the incidence of access related bleeding, iliofemoral vascular injury, and postoperative groin complications associated with EVAR. Increased utility of low profile devices may therefore help to decrease overall morbidity as well as costs attributable to these complications.