Aortic neck enlargement after endovascular aneurysm repair using balloon-expandable versus self-expanding endografts

Abstract

EVAR using SES endografts resulted in progressive infrarenal aortic neck enlargement, whereas EVAR using BES endografts resulted in no neck enlargement over time. These data suggest that infrarenal neck enlargement after EVAR with SES endografts is likely related to the force exerted by SES elements rather than disease progression in the infrarenal neck.

Endovascular Management of Abdominal Aortic Aneurysms: the Year in Review

“…Consider iliac branch device 6.5 mm) over 3 years in the self-expanding stent group, with no significant enlargement in the Nellix group (p G 0.0001). These findings suggest that the mechanism involved with neck expansion post-EVAR may be related to the radial force of self-expanding stents as opposed to disease progression [19]. Similarly, with the use of the Ovation endograft, there was no dilatation of the aortic neck at 2-year follow-up in 89 patients.…”

Proximal Aortic Neck Progression: Before and After Abdominal Aortic Aneurysm Treatment

“…In a recent comparative study by Savlovskis et al, repair with certain type of self-expandable stent (SES)—endografts (Nellix; Endologix, Irvine, CA, USA) caused progressive infrarenal aortic neck enlargement although repair with BES endografts did not cause any neck enlargement after a 24–34 months follow-up (34). Additionally, Peirano et al showed that the diameter reached at initial deployment did not increase further in the long term, which supports the safety and reliability of a modular BES graft and illustrates that this device does not produce dilatation of the proximal neck after deployment (35).…”

A Novel methodology for improved imaging analysis pre- and post-EVAR

“…Figure 2.1 shows an example of potential endograft kinking in a postoperative scan in a highly curved aorta, whereas an aorta with similar angulation but lower curvature shows no signs of kinking. The hypothesis of increased risk for migration is supported by findings of Figueroa et al 14 They show how the increase in aortic curvature leads to higher displacement forces in a 3D computational analysis.…”

“…The RC is defined as 1.96 times the standard deviation of the difference between two repeated measurements covering 95% of the expected variation. 14 The ICC was tested with a two-way mixed model by absolute agreement. All measurements, including defining the centerline, the mesh of the aortic lumen, and measurements of the coordinates and distances, were independently performed by the two observers.…”

“…14,15 Endografts expanded more in the type IA endoleak and migration groups, suggesting this is a prominent risk factor. Radial forces of a fully expanded endograft are reduced significantly, so migration resistance will only depend on active fixation provided by hooks or pins.…”