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

Filis, Konstantinos; Galyfos, George; Sigala, Fragiska; Tsioufis, Κonstantinos; Tsagos, Ioannis; Karantzikos, Georgios; Bakoyiannis, Christos; Zografos, George

doi:10.3389/fsurg.2017.00023

Cited by 15 publications

(11 citation statements)

References 61 publications

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“…1 Despite the improvement in endografts (eg, suprarenal fixation and anchoring hooks and pins), migration remains a complication that may lead to late type Ia endoleak. [2][3][4][5] Spanos et al 5 demonstrated a 8.6% migration rate after EVAR, of which 22.4% of cases had concomitant type I endoleak.…”

Section: Introductionmentioning

confidence: 99%

Effect of Different EndoAnchor Configurations on Aortic Endograft Displacement Resistance: An Experimental Study

et al. 2019

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Purpose: This study investigated the effect of different EndoAnchor configurations on aortic endograft displacement resistance in an in vitro model. Materials and Methods: An in vitro model was developed and validated to perform displacement force measurements on different EndoAnchor configurations within an endograft and silicone tube. Five EndoAnchor configurations were created: (1) 6 circumferentially deployed EndoAnchors, (2) 5 EndoAnchors within 120° of the circumference and 1 additional, contralateral EndoAnchor, (3) 4 circumferentially deployed EndoAnchors, (4) 2 rows of 4 circumferentially deployed EndoAnchors, and (5) a configuration of 2 columns of 3 EndoAnchors. An experienced vascular surgeon deployed EndoAnchors under C-arm guidance at the proximal sealing zone of the endograft. A constant force with increments of 1 newton (N) was applied to the distal end of the endograft. The force necessary to displace a part of the endograft by 3 mm was defined as the endograft displacement force (EDF). Two video cameras recorded the measurements. Videos were examined to determine the exact moment 3-mm migration had occurred at part of the endograft. Five measurements were performed after each deployed EndoAnchor for each configuration. Measurements are given as the median and interquartile range (IQR) Q1, Q3. Results: Baseline displacement force measurement of the endograft without EndoAnchors resulted in a median EDF of 5.1 N (IQR 4.8, 5.2). The circumferential distribution of 6 EndoAnchors resulted in a median EDF of 53.7 N (IQR 49.0, 59.0), whereas configurations 2 through 5 demonstrated substantially lower EDFs of 29.0 N (IQR 28.5, 30.1), 24.6 N (IQR 21.9, 27.2), 36.7 N, and 9.6 N (IQR 9.4, 10.0), respectively. Decreasing the distance between the EndoAnchors over the circumference of the endograft increased the displacement resistance. Conclusion: This in vitro study demonstrates the influence EndoAnchor configurations have on the displacement resistance of an aortic endograft. Parts of the endograft where no EndoAnchor has been deployed remain sensitive to migration. In the current model, the only configuration that rivaled a hand-sewn anastomosis was the one with 6 EndoAnchors. A circumferential distribution of EndoAnchors with small distances between EndoAnchors should be pursued, if possible. This study provides a quantification of different EndoAnchor configurations that clinicians may have to adopt in clinical practice, which can help them make a measured decision on where to deploy EndoAnchors to ensure good endograft fixation.

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Section: Introductionmentioning

confidence: 99%

Effect of Different EndoAnchor Configurations on Aortic Endograft Displacement Resistance: An Experimental Study

et al. 2019

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“…29,30 Also Cao et al 24 concluded that AND is common at midterm follow-up but shows little tendency to progress at a mean follow-up of 18 months, although late reintervention was most frequently necessary in a small number of patients who developed severe ongoing AND. Although several studies do raise concern regarding continuing AND, 4,31 these results imply that midterm AND is not necessarily a clinical problem and may be misinterpreted from the observation of stent-graft expansion. Moreover, the apparent absence of AND after treatment with balloon-expandable stent-grafts.…”

Section: Discussionmentioning

confidence: 99%

Evolution of the Proximal Sealing Rings of the Anaconda Stent-Graft After Endovascular Aneurysm Repair

et al. 2018

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Purpose: To provide insight into the evolution of the saddle-shaped proximal sealing rings of the Anaconda stent-graft after endovascular aneurysm repair (EVAR). Methods: Eighteen abdominal aortic aneurysm patients were consecutively enrolled in a single-center, prospective, observational cohort study (LSPEAS; Trialregister.nl identifier NTR4276). The patients were treated electively using an Anaconda stent-graft with a mean 31% oversizing (range 17–47). According to protocol, participants were to be followed for 2 years, during which 5 noncontrast electrocardiogram-gated computed tomography scans would be conducted. Three patients were eliminated within 30 days (1 withdrew, 1 died, and a third was converted before stent-graft deployment), leaving 15 patients (mean age 72.8±3.7 years; 14 men) for this analysis. Evolution in size and shape (symmetry) of both proximal infrarenal sealing rings were assessed from discharge to 24 months using dedicated postprocessing algorithms. Results: At 24 months, the mean diameters of the first and second ring stents had increased significantly (first ring: 2.2±1.0 mm, p<0.001; second ring: 2.7±1.1 mm, p<0.001). At 6 months, the first and second rings had expanded to a mean 96.6%±2.1% and 94.8%±2.7%, respectively, of their nominal diameter, after which the rings expanded slowly; ring diameters stabilized to near nominal size (first ring, 98.3%±1.1%; second ring, 97.2%±1.4%) at 24 months irrespective of initial oversizing. No type I or III endoleaks or aneurysm-, device-, or procedure-related adverse events were noted in follow-up. The difference in the diametric distances between the peaks and valleys of the saddle-shaped rings was marked at discharge but became smaller after 24 months for both rings (first ring: median 2.0 vs 1.2 mm, p=0.191; second ring: median 2.8 vs 0.8 mm; p=0.013). Conclusion: Irrespective of initial oversizing, the Anaconda proximal sealing rings radially expanded to near nominal size within 6 months after EVAR. Initial oval-shaped rings conformed symmetrically and became nearly circular through 24 months. These findings should be taken into account in planning and follow-up.

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“…24 Immune pathways are upregulated within the nondilated aorta proximal to the aneurysmal segment, and these areas have demonstrated histologic signs of destruction. 32 An increased aneurysmal burden demonstrated by the presence of larger aortic neck diameters and AAA size has been shown to be an independent risk factor for continuing aortic neck dilation. 32,33 Thus, large aortic neck diameters may already be damaged and weakened so that endovascular devices that could initially achieve a sufficient seal will ultimately develop endoleaks over time.…”

Section: Discussionmentioning

confidence: 99%

Comparative study of clinical outcome of endovascular aortic aneurysms repair in large diameter aortic necks (>31 mm) versus smaller necks

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et al. 2018

Journal of Vascular Surgery

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

Cited by 15 publications

References 61 publications

Effect of Different EndoAnchor Configurations on Aortic Endograft Displacement Resistance: An Experimental Study

Effect of Different EndoAnchor Configurations on Aortic Endograft Displacement Resistance: An Experimental Study

Evolution of the Proximal Sealing Rings of the Anaconda Stent-Graft After Endovascular Aneurysm Repair

Comparative study of clinical outcome of endovascular aortic aneurysms repair in large diameter aortic necks (>31 mm) versus smaller necks

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