A comparative analysis of the outcomes of aortic cuffs and converters for endovascular graft migration

Abstract

Proximal attachment failure and graft migration are potentially lethal complications of EVAR. Proximal graft extension using an aortic cuff is the easiest technique for salvaging an endovascular graft. Unfortunately, it has a predictable failure mode (development of a type III endoleak due to component separation) and is associated with a significantly higher failure rate than with the use of a converter. EVAR salvage with a converter and a femorofemoral bypass is a more complex but superior option for endovascular graft salvage.

Stent Graft Dislocation after EVAR Treated with an Endostapling Fixation System

“…Although endostaples prevented complications requiring open reinterventions that would be a more expensive solution, the double endovascular procedure we needed in our case is certainly not costeffective. In general the use of only proximal extension for distal migration of a stent-graft in hostile anatomy is associated with a significantly higher failure (11,12). Fixation of the stent-graft with endostaples can prevent this migration being eventually a less invasive and less expensive long-term solution.…”

Midterm outcomes of the Zenith Renu AAA Ancillary Graft

“…27 A previous report of the short-term data from this registry suggested that the converter configuration was the better reconstructive option compared with the main body extension. 10 While the comparison between the two configurations was not repeated during this study, further analyzes are pending to evaluate this variable, as well as other factors, as follow-up for patients in this registry is ongoing.…”

“…Additional details regarding the IFU as well as the device description have previously been reported (Appendix, online only). 10 Implantation procedure. Before implantation, all cases were reviewed by a member of the physician review committee to ensure anatomic suitability and that patients met the IFU for the device.…”

Active Proximal Sealing in the Endovascular Repair of Abdominal Aortic Aneurysms

“…[4][5][6][7][8] The design of contemporary endografts involves specific mechanisms to help accomplish and maintain adequate fixation, such as columnar strength provided by the design of the stent-graft body; suprarenal bare stents incorporating into the aortic wall; suprarenal or infrarenal barbs, pins, hooks, or anchors; or even endostaples or endoanchors. 4,[9][10][11] Enhancing the proximal seal of the device, rather than just fixation, is another means of preventing proximal endoleak and migration; few manufacturers have addressed this in their device design to date.…”