Longitudinal Aneurysm Shrinkage Following Endovascular Aortic Aneurysm Repair: A Source of Intermediate and Late Complications

Abstract

In this study, longitudinal shrinkage of the sac following endovascular aortic aneurysm repair led to buckling or kinking of the endograft within 1 year in 69% of patients. This appears to be an important source of delayed complications.

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

“…In addition, kinking may cause displacement of the iliac graft limb and subsequent secondary endoleak. Harris et al 7 reported a 69% incidence of buckling or kinking of endografts within 1 year. In our 2-year observation period, we saw moderate to severe changes in Ͼ50% of the Vanguard devices and observed a permanent change in stentgraft anatomy that continued to progress throughout follow-up.…”

“…[1][2][3][4][5][6] However, now that data from longer follow-up are becoming available, reports of secondary sequelae are appearing. [7][8][9] As one example, Harris et al 7 reported significant stent-graft kinking and buckling induced by longitudinal aneurysm shrinkage in almost 70% of their 26 cases after only 1 year.…”

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

“…The first mechanism is the “accordion effect.” The shortening of the endovascular stent graft after release is followed by re-expansion of the stent itself to its natural length as a result the gradual distortion of the stent [8]. After EVAR, the vessel remodeling effect on the stent graft leads to kinking with an associated risk of endovascular stent graft occlusion [9]. Migration of the stent graft at the level of the proximal or distal fixation has also been reported as the cause of such geometric distortion.…”

Endovaskuläre Aneurysmatherapie: Radiologisch-makropathologische Befundkorrelation der endoluminalen Oberfläche einer modularen Stentprothese

“…Stauchungen des Stentgerüstes können erhebliche Faltenbildungen der Stentmembran verursachen. Entsprechende Befunde werden im Rahmen der klinischen Nachsorge mittels Radiographie erkannt [7,8,10,12,13]. Die damit verbundenen Fältelungen der Hüllmembran können den Blutfluss behindern und endoluminale Thrombusbildungen verursachen.…”