The Relationship between Temporal Changes in Proximal Neck Angulation and Stent-Graft Migration after Endovascular Abdominal Aortic Aneurysm Repair

Abstract

There was a significant change in the neck angle between the preoperative condition and the immediate postoperative condition. However, there was no clear relationship found between the angle of the neck and the proximal stent-graft migration. Postoperative changes in the proximal neck angle just after EVAR and subsequent temporal changes during a 2-year follow-up period do not appear to predict stent-graft migration, secondary intervention rates, or the occurrence of endoleak.

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

“…Additionally, no correlation between the dilatation of proximal and distal landing levels is observed (14). Concerning changes in the neck angle between the preoperative condition and the immediate postoperative condition, data show that there is no clear relationship found between only the angle of the neck and proximal stent-graft migration (46, 47). Especially in large AAAs, we have found that there is a 15% increase in neck angulation and a 27% decrease in neck length after EVAR, compared to small AAAs, with no difference in outcome (48).…”

Pre-operative Aortic Neck Characteristics and Post-operative Sealing Zone as Predictors of Type 1a Endoleak and Migration After Endovascular Aneurysm Repair: A Systematic Review and Meta-Analysis

“…40 infrarenal angulation) was not significantly different between the migration group and the controls (OR 0.98, 95% CI 0.16 e 5.2; p ¼ .98). 50 Bastos Goncalves et al 44 found that neck angulations > 60 suprarenal or 75 infrarenal were not independent risk factors for type 1a endoleak and migration. Moreover, suprarenal and infrarenal angulation were not significantly different between the type 1a endoleak and migration group (diagnosed > 1 year after the initial EVAR procedure) and controls (p ¼ .74 and p ¼ .54, respectively).…”

“…Neck length was significantly different between the migration group (migration ! 3 mm) and controls (21.3 AE 6.8 mm vs. 28.3 AE 12.4 mm, respectively; p ¼ .020),50 and between patients with migration and or type 1a endoleak (diagnosed > 1 year after the initial EVAR procedure) and controls (14.0 mm, interquartile range [IQR] 7.0 e 28.3 mm vs. 24.1 mm, IQR 5.1 e 33.0 mm, respectively; p ¼ .013).…”

“…endoleak or migration (p ¼ .40),44 and neck diameter divided by endograft diameter was not significantly different between the migration group (migration ! 3 mm) and control group (0.866 AE 0.054 vs. 0.885 AE 0.051, respectively; p ¼ .311) 50. Neck length.…”

The incidence and effect of noncylindrical neck morphology on outcomes after endovascular aortic aneurysm repair in the Global Registry for Endovascular Aortic Treatment

“…25 The EXCLUDER endograft is also commonly selected for use in patients with significant angulation. 17,[26][27][28][29] This might be because of the appeal of certain unique design characteristics of the device, aimed at enabling flexibility and conformability to the aortic wall even in cases of severe angulation or diameter change within the seal zone. The device features a smaller amplitude pattern than most stents, which might enable the device to better accommodate the changing diameter of the aorta.…”