From 1999-2001, I had the pleasure of working with Drs Michael L Marin and Bruce Brener as a fellow in the early stages of The US trial for the Talent EVAR device. I recall it as a very exciting time. It was prior to FDA approval of any aortic stent graft device. As part of the FDA trial, access to the Talent device meant the ability to treat a broad spectrum of challenging aortic anatomy. Especially the proximal neck which was and still remains the "achilles heal" of EVAR
Turnbull et al describe the typical characteristics that must be fulfilled for EVAR 1) aortic neck diameter 28mm, aortic neck length >15mm, aortic neck angulation <60 degrees and access artery >7mm. Additional factors include the presence of the aortic neck mural thrombus and iliac vessel tortuosity or calcification. Clearly, these indication and limitations have be altered as technology has evolved.
Manis et al described 50% of people with AAA's following under the category of anatomically prohibitive. Talent Abdominal Stent Graft (Medtronic Vascular, Santa Rosa, CA) provides an FDA approved option for treatment of challenging aortic neck anatomy. It enters the field with the Zenith (Cook, Bloomington,IN). The Talent device, first introduced in 1995 has been deployed in over 40,000 people worldwide. It is a self expanding modular system composed of shaped nitinol stents covered with a woven polyester fabric. Proximally, it has 15mm of uncovered stent that provides suprarenal fixation
The current iteration has a thinner, low profile graft fabric called the LPS (low porosity system). The nitinol springs have been chemically treated to improve durability. The iliac longitudinal connecting bar has been moved from lateral to medial to decrease the risk of kinking and tromboses.
Espinosa in The Journal of Endovascular Surgery demonstrated resistance from material fatigue in 193 patients treated with Talent LPS, showing no fracture, aneurysm rupture, limb occlusion and only one fatal disconnect at 6 years.
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