title: Endovascular Treatment of Infrarenal Aneurysms: Comparison of the Results of Second- and Third-Generation Stent Grafts.
abstract: BACKGROUND
  The stent grafts used for endovascular abdominal aortic repair (EVAR) profited from many technological changes since their appearance. The objective of this study was to compare the medium-term results of the second- and third-generation stent grafts.
  
  
  METHODS
  Three hundred thirty-four patients treated by EVAR between 2005 and 2013 were included in this retrospective study. Demographic, anatomical, perioperative, and follow-up data were collected in a prospective way in an electronic database and compared between 2 groups. The preoperative angio-computed tomographies were all analyzed in depth on a suitable three-dimensional work station. Group 1 (n = 219) represented the patients treated by second-generation stent grafts (Medtronic Talent(®), Cook Medical Zenith Flex(®), Vascutek-Terumo Anaconda(®), Gore Excluder low-porosity(®)) and group 2 (n = 115) represented the patients treated with third-generation stent grafts (Medtronic Enduring I and II(®), Cook Medical Zenith LP(®), Gore Excluder C3(®)).
  
  
  RESULTS
  The mean follow-up was 42.4 ± 26.8 months with a longer duration in group 1 (52.4 ± 27.2 vs. 23.2 ± 10.9 months, P < 0.0001). The patients of group 2 had significantly more risk factors and cardiovascular comorbidities (coronary disease, tobacco addiction, dyslipidemia, peripheral arterial disease, chronic renal insufficiency). Anatomical characteristics were similar in the 2 groups, in particular regarding the iliac arteries which were significantly more calcified and had a smaller diameter in group 2. The rate of perioperative complications was similar in the 2 groups, in particular for complications related to the iliac axes (3.7% vs. 2.6%, P = 0.96). During the follow-up, there was no significant difference between the 2 groups in the rates of survival, reinterventions, or endoleaks and the progression of the aneurysmal sac.
  
  
  CONCLUSIONS
  This study shows that third-generation stent grafts allow results comparable with those of the second-generation stent grafts in spite of more complex iliac anatomies. These results make it possible to expand the indications of EVAR to patients presenting more cardiovascular comorbidities without increasing the risk of complications in the short and medium term.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, CHU de Rennes, Rennes, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Maudet
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, CHU de Rennes, Rennes, France; INSERM U1099, Rennes, France; University of Rennes 1, Signal and Image Processing Laboratory, Rennes, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Daoudal
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, CHU de Rennes, Rennes, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Cardon
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, CHU de Rennes, Rennes, France.
authors.forename: Elodie
authors.initials: E
authors.lastname: Clochard
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, CHU de Rennes, Rennes, France; INSERM U1099, Rennes, France; University of Rennes 1, Signal and Image Processing Laboratory, Rennes, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Lucas
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, CHU de Rennes, Rennes, France; INSERM U1099, Rennes, France; University of Rennes 1, Signal and Image Processing Laboratory, Rennes, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Verhoye
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, CHU de Rennes, Rennes, France; INSERM U1099, Rennes, France; University of Rennes 1, Signal and Image Processing Laboratory, Rennes, France. Electronic address: kaladrien@hotmail.fr.
authors.forename: Adrien
authors.initials: A
authors.lastname: Kaladji
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D011474:Prosthesis Design; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome