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

Abstract

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.

Endograft platform does not influence aortic neck dilatation after infrarenal endovascular aneurysm repair with primary endostapling

“…21 EndoAnchors likely constrain the neck by achieving transmural aorto-prosthetic fixation, with suggestions that AND is attenuated by endostapling. 8,25 Furthermore, endostapling may also reduce subtle endograft surface movement, which has been implicated in the development of endoleaks, 26 and may be linked to the high incidence of sac shrinkage in this series as also noted in other studies. 27,28 The neck diameter-related results presented here echo that of other studies, which indicate that AND continues despite endostapling, the role of which may be thus to maintain endograft-to-aortic wall fixation/apposition in preventing both migration and endoleakage, which are the recognised ill-effects of AND, and this conforms to current hypotheses regarding how endostaples are protective.…”

Single centre experience with Excluder® stent graft; 17-year outcome

“… 40 , 41 This is probably caused by the progression of the disease as well as by material failure due to constant forces present in the aorta, distortion of anatomy due to new hemodynamics, dilatation of the common iliac arteries or progress of previous iliac arteries ectasia. 42 , 43 , 44 The follow-up protocol should be carefully adjusted since higher post-EVAR imaging frequency has been associated with a lower risk of death but attributed to higher cost and irradiation dose. 4 , 24 , 45 The current recommendations propose imaging at 30 days after the procedure and yearly thereafter if no complications are detected.…”

Structural failure in bridging stentgrafts for branched endovascular aneurysm repair: a case–control study

“…The demographics, comorbidities and aneurysm characteristics in the patients with structural failures were not different from other typical EVAR patient cohorts [ 1 , 17 ]. Potentially certain arterial movements (respiratory or pulsatile) may play a role in premature material degradation, as they have been found to be associated with endoleak formation in conventional EVAR [ 18 ]. However, dynamic pre- and postintervention CT studies are not routinely performed.…”