Geometric Changes in Aortic Endografts over a 2-Year Observation Period

Krämer, Stefan; Seifarth, Harald; Pamler, Reinhard; Fleiter, Thorsten; Görich, Johannes

doi:10.1177/152660280100800105

Cited by 28 publications

(14 citation statements)

References 13 publications

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“…EVAR should not be considered to be a single-step procedure, based on preoperative anatomical features alone. During pre-procedure planning, one should be aware of the ongoing process of conformational geometrical changes of the stent-graft and the diseased aorta [30, 31]. In this context, an intact proximal sealing zone is of crucial importance for stent-graft stability and integrity, preventing distal migration, stent-graft-related endoleaks, and, ultimately, aortic rupture.…”

Section: Discussionmentioning

confidence: 99%

“…Displacement forces and stent-graft stability are also related to the iliac fixation [14, 37]. Through distal fixation, different authors have identified the docking area of the modular stent graft limb as a vulnerable region, which seems to be exposed to the highest mechanical stress [31] and surface movement [15]. Taking into account that the modular limb was predominantly left-sided (78%) in our cohort, the left iliac sealing diameter was significantly associated with an increased stent-graft surface movement in the univariate, but not in the multivariate, analysis.…”

Section: Discussionmentioning

confidence: 99%

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Stent-graft surface movement after endovascular aneurysm repair: baseline parameters for prediction, and association with migration and stent-graft-related endoleaks

et al. 2019

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ObjectivesTo evaluate the influence of baseline parameters on the occurrence of stent-graft surface movement after endovascular aneurysm repair (EVAR) and to investigate its association with migration and stent-graft-related endoleaks (srEL).MethodsIn this retrospective, cross-sectional study, three-dimensional surface models of the stent-graft, delimited by landmarks using custom-built software, were derived from the pre-discharge and last follow-up computed tomography angiography (CTA). Stent-graft surface movement in the proximal anchoring zone between these examinations was considered significant at a threshold of 9 mm. The Cox proportional hazards model was used to determine baseline variables associated with the occurrence of stent-graft surface movement. The association between migration and srEL with stent-graft surface movement was tested with the chi-square and the Fisher exact test, respectively.ResultsStent-graft surface movement was observed in 54 (28.9%) of 187 patients. Multivariate analysis revealed that age ([HR] 1.05; p = 0.017), proximal neck diameter ([HR] 5.07; p < 0.001), infrarenal aortic neck angulation ([HR] 1.02, p = 0.002), and proximal neck length ([HR] 0.62, p < 0.001) were significantly associated with the occurrence of stent-graft surface movement. Migration and srEL occurred in 17 (31.5%) and 5 (9.3%) patients, with and 11 (8.3%) and 2 (1.5%) without stent-graft surface movement (p < 0.001, p = 0.022).ConclusionsAge, neck diameter, infrarenal neck angulation, and proximal neck length were significantly associated with the occurrence of stent-graft surface movement. Apart from possible use of adjunctive sealing systems, concerned patients may benefit from regular CTA surveillance, enabling timely diagnosis of subtle changes of stent-graft position.Key Points • Stent-graft surface movement, demonstrating subtle, three-dimensional changes in stent-graft position in the proximal anchoring zone, can be derived from CTA examinations. • Age, proximal neck diameter, and infrarenal neck angulation were significantly associated with an increased incidence of stent-graft surface movement. Stent-graft surface movement is significantly more frequent in patients with stent-graft migration and stent-graft-related endoleaks. • Consideration of risk factors for stent-graft surface movement may help to identify patients who might benefit from regular CTA surveillance and timely diagnosis of subtle changes of stent-graft position, enabling re-interventions to prevent migration and srEL. Electronic supplementary materialThe online version of this article (10.1007/s00330-019-06282-w) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Stent-graft surface movement after endovascular aneurysm repair: baseline parameters for prediction, and association with migration and stent-graft-related endoleaks

et al. 2019

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“…Kinking of the aortic stent graft may cause endoleak and possible graft rupture [4]. The reported incidence of graft kinking within a mean follow-up of 22 month is 3.7% [5].…”

Section: Discussionmentioning

confidence: 99%

A Case of Endovascular Treatment of Severe Graft Limb Kinking after Endovascular Abdominal Aortic Aneurysm Repair

Shin

Park

Jeong

et al. 2016

VSI

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Endovascular aneurysm repair (EVAR) has been recommended as an alternative to open aneurysm repair. The risk of severe perioperative complications is lower than that in open surgical repair; however, late complications are more likely. After EVAR, regular yearly surveillance by duplex ultrasonography or computed tomography is recommended. We report the case of a 67-year-old man with a severely kinked left iliac branch of the stent graft 10 years after EVAR. He had not undergone regular follow-up during the last 4 years. We realigned the endograft kink by percutaneous transluminal angioplasty.

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“…Until recently, all aortic endografts have had similar design morphology, typically of a bifurcated fabric-stent with proximal and distal attachments that fix and seal the device to the non-aneurysmal aorta and the iliac arteries. However, there are ongoing concerns regarding the long term outcomes of these devices, with migration, endo-leaks, aneurysm enlargement and rupture all potential risks [1][2][3][4]. Up to 2009, the infra-renal devices approved by the United States Food and Drug Administration (FDA) and European Medicines Agency (EMA) all achieved seal and longitudinal fixation through hooks, barbs, suprarenal stents, radial force and columnar rigidity [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Nellix Endovascular Aneurysm Sealing System (EVAS): A New Concept in Endovascular Repair - What the Radiologist Needs to Know

Weller¹,

Am²,

Ar³

et al. 2016

J Vasc Med Surg

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The Nellix endovascular aneurysm sealing system (EVAS), licensed in Europe for treating infrarenal abdominal aortic aneurysms, has distinctive design comprising two balloon-expandable endoframes, each surrounded by a polymer-filled endobag.This review describes the current role of CT in both Nellix follow-up and pre-procedure planning, with reference to the inclusion criteria for Nellix insertion and the deployment technique. Knowledge of the expected evolution of CT features following Nellix insertion is important for recognizing potential complications. Examples of normal post-operative CT appearance, as well as complications seen to date are discussed.

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Geometric Changes in Aortic Endografts over a 2-Year Observation Period

Cited by 28 publications

References 13 publications

Stent-graft surface movement after endovascular aneurysm repair: baseline parameters for prediction, and association with migration and stent-graft-related endoleaks

Stent-graft surface movement after endovascular aneurysm repair: baseline parameters for prediction, and association with migration and stent-graft-related endoleaks

A Case of Endovascular Treatment of Severe Graft Limb Kinking after Endovascular Abdominal Aortic Aneurysm Repair

Nellix Endovascular Aneurysm Sealing System (EVAS): A New Concept in Endovascular Repair - What the Radiologist Needs to Know

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