Influence of Severe Infrarenal Aortic Neck Angulation on Complications at the Proximal Neck Following Endovascular AAA Repair: A EUROSTAR Study

Hobo, Roel; Kievit, J.K.; Leurs, Lina J.; Buth, Jacob

doi:10.1583/06-1914.1

Cited by 205 publications

(230 citation statements)

References 29 publications

(35 reference statements)

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“…Leurs,et al 14) found that a neck length <15mm was associated with significantly increased rates of early (<30 days) and late proximal type I EL. Similarly, Hobo, et al 15) showed that severe proximal neck angulation (>60 degrees) was associated with higher rates of early proximal type I EL and graft migration. A review by Fulton,et al 10) demonstrated that patients treated outside of the IFU experienced higher rates of graft migration, devicerelated complications, and secondary interventions.…”

Section: Discussionmentioning

confidence: 89%

“…They concluded that the application of EVAR outside of the anatomically specific IFU variables was associated with an incremental negative effect on the late results, indicating that adherence to such IFU guidelines is appropriate in clinical practice. In a series of articles from the EUROSTAR database, 10,[13][14][15] the investigators studied the effects of an aneurysm sac and neck diameter, neck length, and neck angulation on late outcomes. Waasdorp, et al 13) showed higher rates of aneurysm rupture, open conversion and mortality in patients with a sac diameter >6 cm or with a neck diameter >26 mm after 4 years of follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…This result differed from previous reports. [13][14][15] It might be due to anatomical deviation in o-IFU group, which was in permissible range. In our study, the most common parameter outside of the IFU was challenging neck, so we investigated the effect of challenging neck anatomy on early and mid-term outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Even though few studies have addressed the effect of device type and the anatomical selection criteria on the clinical outcomes, [10][11][12] some investigators [13][14][15] mentioned that the challenging neck anatomy, for example neck diameter, neck length, and neck angulation effected on early and late outcomes.…”

mentioning

confidence: 99%

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Outcomes Following Endovascular Abdominal Aortic Aneurysm Repair Both Within and Outside of the Instructions for Use

Igari

Kudo

Toyofuku

et al. 2014

ATCS

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Outcomes Following Endovascular Abdominal Aortic Aneurysm Repair Both Within and Outside of the Instructions for Use

Igari

Kudo

Toyofuku

et al. 2014

ATCS

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“…7 A number of factors hypothesized to affect device migration have been clinically investigated, including aortic neck diameter, length, and angulation; neck calcification and thrombus; neck enlargement; inadequate proximal and distal fixation length; and neck enlargement. [8][9][10] In-vitro 11 and in-vivo experimental studies, 12 as well as theoretical 13 and computational studies, [14][15][16][17][18][19] have been conducted to investigate the magnitude of the loads acting on endografts. These loads have been referred to as migration forces, displacement forces, or drag forces.…”

mentioning

confidence: 99%

Effect of Curvature on Displacement Forces Acting on Aortic Endografts: A 3-Dimensional Computational Analysis

Figueroa

Taylor

Yeh

et al. 2009

Journal of Endovascular Therapy

109

114

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¤ ¤Purpose: To determine the effect of curvature on the magnitude and direction of displacement forces acting on aortic endografts in 3-dimensional (3D) computational models.Method: A 3D computer model was constructed based on magnetic resonance angiography data from a patient with an infrarenal aortic aneurysm. Computational fluid dynamics tools were used to simulate realistic flow and pressure conditions of the patient. An aortic endograft was deployed in the model, and the displacement forces acting on the endograft were calculated and expressed in Newtons (N). Additional models were created to determine the effects of reducing endograft curvature, neck angulation, and iliac angulation on displacement forces. Results: The aortic endograft had a curved configuration as a result of the patient's anatomy, with curvature in the anterolateral direction. Total displacement force acting on the endograft was 5.0 N, with 28% of the force in a downward (caudal) direction and 72% of the force in a sideways (anterolateral) direction. Elimination of endograft curvature (planar graft configuration) reduced total displacement force to 0.8 N, with the largest component of force (70%) acting in the sideways direction. Straightening the aortic neck in the curved endograft configuration reduced the total force acting on the endograft to 4.2 N, with a reduction of the sideways component to 55% of the total force. Straightening the iliac limbs of the endograft reduced the total force acting on the endograft to 2.1 N but increased the sideways component to 91% of the total force. Conclusion: The largest component of the force acting on the aortic endograft is in the sideways direction, with respect to the blood flow, rather than in the downward (caudal) direction as is commonly assumed. Increased curvature of the aortic endograft increases the magnitude of the sideways displacement force. The degree of angulation of the proximal and distal ends of the endograft influence the magnitude and direction of displacement force. These factors may have a significant influence on the propensity of endografts to migrate in vivo.

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The Technological Advancement to Engineer Next‐Generation Stent‐Grafts: Design, Material, and Fabrication Techniques

Vahabli

Mann

Heidari

et al. 2022

Adv Healthcare Materials

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Endovascular treatment of aortic disorders has gained wide acceptance due to reduced physiological burden to the patient compared to open surgery, and ongoing stent-graft evolution has made aortic repair an option for patients with more complex anatomies. To date, commercial stent-grafts are typically developed from established production techniques with simple design structures and limited material ranges. Despite the numerous updated versions of stent-grafts by manufacturers, the reoccurrence of device-related complications raises questions about whether the current manfacturing methods are technically able to eliminate these problems. The technology trend to produce efficient medical devices, including stent-grafts and all similar implants, should eventually change direction to advanced manufacturing techniques. It is expected that through recent advancements, especially the emergence of 4D-printing and smart materials, unprecedented features can be defined for cardiovascular medical implants, like shape change and remote battery-free self-monitoring. 4D-printing technology promises adaptive functionality, a highly desirable feature enabling printed cardiovascular implants to physically transform with time to perform a programmed task. This review provides a thorough assessment of the established technologies for existing stent-grafts and provides technical commentaries on known failure modes. They then discuss the future of advanced technologies and the efforts needed to produce next-generation endovascular implants.

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Influence of Severe Infrarenal Aortic Neck Angulation on Complications at the Proximal Neck Following Endovascular AAA Repair: A EUROSTAR Study

Cited by 205 publications

References 29 publications

Outcomes Following Endovascular Abdominal Aortic Aneurysm Repair Both Within and Outside of the Instructions for Use

Outcomes Following Endovascular Abdominal Aortic Aneurysm Repair Both Within and Outside of the Instructions for Use

Effect of Curvature on Displacement Forces Acting on Aortic Endografts: A 3-Dimensional Computational Analysis

The Technological Advancement to Engineer Next‐Generation Stent‐Grafts: Design, Material, and Fabrication Techniques

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