Separation of Components in Fenestrated and Branched Endovascular Grafting – Branch Protection or a Potentially New Mode of Failure?

Abstract

Objectives: Modular component separation following endovascular aortic repair is recognized as a potential source of late failure. The aim of this study was to establish the extent of component separation occurring in branched and fenestrated endografts and to ascertain any factors that predict its occurrence.Design: An analysis of component relationships following fenestrated and branched endovascular aneurysm repair was conducted on all patients with Ͼ1 year of digital imaging data. A mathematical model was developed, and retrospectively applied, to determine the minimum stentgraft overlap required to preclude any risk of component separation.Results: Of the 184 patients treated prior to 2006, data (for patients with greater than 1 year follow-up) were available for 106 patients. Fourteen (13%) had evidence of inter-component movement of which 8 developed component separation (Ͻ2 stent overlap). All 8 patients with component separation, in addition to 38% of the total cohort, were identified as being at risk for eventual component separation using the mathematical model.Conclusions: Component movement is commonly observed in modular devices, but clinical consequences are rare. The degree of overlap, aneurysm diameter, aneurysm length, and stentgraft diameter can be used to predict the risk of inter-component movement which may result in component separation.

Multicenter retrospective investigation into migration of fenestrated aortic stent grafts

“…Here the displacement forces act at the aortic bifurcation on to the distal component, thereby preventing proximal movement. 21 Our study has some limitations. The effect of any missing patients must be considered.…”

Pararenal aortic aneurysm repair using fenestrated endografts

“…Only the largest, most complete series were used, leading to a reduction of 15 articles. 2,[28][29][30][31][32][33][34][35][36][37][38][39][40][41] Study quality. Nine studies were included in this analysis.…”

Intermediate results of a United States multicenter trial of fenestrated endograft repair for juxtarenal abdominal aortic aneurysms

“…22 The fenestrated device has a modular design that allows for relative movement of the proximal fenestrated component and distal bifurcated component. 23 Thus, forces causing migration are not directly transmitted from one component to the other. In addition, the two components can adjust independently to morphologic changes by relative movement, thus diminishing the risk of aneurysm repressurization.…”