Anatomical Risk Factors for Proximal Perigraft Endoleak and Graft Migration Following Endovascular Repair of Abdominal Aortic Aneurysms

Albertini, Jean‐Noël; Kalliafas, Stavros; Travis, Simon; Yusuf, Salim; Macierewicz, Jan; Whitaker, S. C.; Elmarasy, NM; Hopkinson, BR

doi:10.1053/ejvs.1999.1045

Cited by 150 publications

(111 citation statements)

References 6 publications

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“…First, actual landing zone of neck was shorter than the angulated neck procedure because of the presence of the SRNA. Because deployment of stent graft lower than SRNA had a risk for migration of it with type 1 endoleak, 18) coverage of the SRNA in type 3 morphology might be important. Indeed, type 3 morphology comprised majority of angulated neck AAA and the distance from the lower renal artery to the SRNA of this type was only 7-22 mm in current study.…”

Section: Discussionmentioning

confidence: 99%

Kilt Technique as an Angle Modification Method for Endovascular Repair of Abdominal Aortic Aneurysm with Severe Neck Angle

Kim

Jang

Choi

et al. 2017

ATCS

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Purpose: Kilt technique can be useful for overcoming the severe angle in endovascular abdominal aortic repair. Thus, we investigate the utility of the Kilt technique as an angle modification method. Methods: This study included 16 patients with abdominal aortic aneurysm having severe neck angle (over 60°). Of these, eight were treated using Kilt technique, whereas the remaining eight were by the conventional endovascular method. We investigated the pre-and post-procedural differences in neck angle between the two groups using aortic computed tomography (CT) angiography. Results: Mean pre-procedural neck angles in the conventional group and the Kilt group were 70° ± 13° and 93° ± 14° (p = 0.007) and supra-renal neck angles were 54° ± 16° and 89° ± 26°, respectively (p = 0.016). However, the angle differences disappeared between the two groups after the procedure. Consequently, the Kilt group showed greater angle change than the conventional group (p value for ∆ supra-renal angle and ∆ neck angle were 0.015 and 0.021, respectively). There was no type 1 endoleak during 16 ± 16 months of CT follow-up. Conclusion: Kilt technique may be an effective tool for modifying the neck angle without leaving increased risk of type 1 endoleak in this subset of patients.

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Section: Discussionmentioning

confidence: 99%

Kilt Technique as an Angle Modification Method for Endovascular Repair of Abdominal Aortic Aneurysm with Severe Neck Angle

Kim

Jang

Choi

et al. 2017

ATCS

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“…The isolated iliac aneurysms have been treated with covered stents [3]. Endoleak is a problem in patients treated by endovascular stent graft implantation [4,5]. We present here a treatment of endoleak that occurred after covered stent implantation of the isolated iliac aneurysm.…”

Section: Discussionmentioning

confidence: 99%

Treatment of type I endoleak in an iliac aneurysm with balloon expandable palmaz stent

et al. 2011

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Endovascular exclusion of the peripheral arterial aneurysms with covered stent grafts have been used to decrease the operative morbidity and mortality in comorbid old patients. However, endoleaks remain a problem. The authors present a case of left common iliac artery aneurysm, which was treated by endovascular therapy. Initially, internal iliac artery was occluded with coil embolization to prevent type II endoleak. A covered self-expandable stent was used for exclusion of the aneurysm. A proximal perigraft leak was detected in control contrast injection. Palmaz balloon expandable stent was used for treatment of proximal perigraft leak. The control angiography showed complete exclusion of the aneurysm and no perigraft leak was detected in the aneurysm sac. Proximal balloon expandable stent implantation as an addition to covered stent in short and angulated necked aneurysms is technically feasible, and this technique provide a good treatment method for proximal perigraft leak.

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“…Because positional stabil-ity of the stent-graft is essential for long-term durability, proximal stent migration is another important potential failure that needs the attention of clinicians. 25,26 There are two possible reasons for stent migration: (1) an increase in the aneurysm neck diameter over time, which decreases friction between the stent-graft and the aortic wall; and (2) the characteristics of proximal fixation. 27 The first situation occurs in both infrarenally and suprarenally fixed stent-grafts because they use radial force to create wall friction that contributes to stability within the aorta.…”

Section: Discussionmentioning

confidence: 99%

Three-Dimensional Visualization of Suprarenal Aortic Stent-Grafts:Evaluation of Migration in Midterm Follow-up

Sun¹

2006

Journal of Endovascular Therapy

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ࡗ ࡗPurpose: To investigate the midterm results of transrenal fixation of abdominal aortic stentgrafts with regard to device migration and encroachment of stent wires on the renal and visceral branches. Methods: Imaging data from 18 patients (15 men; mean age 75 years, range 63-84) undergoing transrenal stent-graft fixation for abdominal aortic aneurysm (AAA) were included in the study. Computed tomographic angiographic data acquired within 1 week of stentgraft implantation were compared to the latest follow-up images. Postprocessing methods generated 3-dimensional (3D) maximum intensity projections (MIP) and virtual intravascular endoscopy (VIE) for evaluation of the relationship between suprarenal stents and aortic branches. Aortic neck angulation was measured in each patient for correlation with the incidence of stent migration. Results:The mean follow-up period was 40 months. 3D image visualizations showed that the stent-graft moved caudally in all patients (range 2.6-14.2 mm), with migration (Ͼ10 mm) observed in 4 (22%) patients. Corresponding VIE images documented changes in stent wire encroachment on the aortic branch ostia in 11 patients, including the number and position of crossing stent wires. There was no close relationship between aortic neck angulation and stent migration. Conclusion:The current study demonstrated that migration occurs at midterm follow-up in transrenally deployed stent-grafts. 3D images were valuable for the assessment of stent migration, as well as its relationship with aortic branch ostia. Long-term follow-up of transrenal fixation deserves to be investigated, especially after observing stent migration relative to aortic ostial encroachment. J Endovasc Ther 2006;13:85-93

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Anatomical Risk Factors for Proximal Perigraft Endoleak and Graft Migration Following Endovascular Repair of Abdominal Aortic Aneurysms

Abstract: neck angulation was the risk factor most significantly related to PPE and graft migration.

Cited by 150 publications

References 6 publications

Kilt Technique as an Angle Modification Method for Endovascular Repair of Abdominal Aortic Aneurysm with Severe Neck Angle

Kilt Technique as an Angle Modification Method for Endovascular Repair of Abdominal Aortic Aneurysm with Severe Neck Angle

Treatment of type I endoleak in an iliac aneurysm with balloon expandable palmaz stent

Three-Dimensional Visualization of Suprarenal Aortic Stent-Grafts:Evaluation of Migration in Midterm Follow-up

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