Thoracic endovascular aortic repair migration and aortic elongation differentiated using dual reference point analysis

Alberta, Hillary B.; Takayama, Tadatoshi; Panthofer, Annalise M.; Cambria, Richard P.; Jordan, William D.; Matsumura, Jon S.

doi:10.1016/j.jvs.2017.07.108

Cited by 13 publications

(10 citation statements)

References 21 publications

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“…2,3 Although aortic morphological changes with aging has been reported, 5 aortic elongation after TEVAR is known to occur as well as a normal aging process. 1–4 Chen et al 4 have reported that aortic elongation after TEVAR occurs over time, with a median change in aortic length from innominate artery to celiac artery of 1.7 mm/year. However, in our case, BMS migration by approximately half of its length occurred within 1 month postoperatively and is considered to be related to another pathogenesis except for whole aortic elongation with aging.…”

Section: Discussionmentioning

confidence: 99%

“…Device migration has been recognized as a serious complication after thoracic endovascular aortic repair (TEVAR) as it may lead to endoleaks, device separation, stent collapse, and branch vessel coverage. 1 Previous studies on device migration have focused on pre-existed aortic morphology (aortic length, diameter, angle, and tortuosity). [1][2][3][4] However, the relationship between device migration and aortic remodeling after TEVAR in aortic dissection has not been highlighted.…”

Section: Introductionmentioning

confidence: 99%

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Unexpected Bare Metal Stent Migration Associated With Aortic Remodeling After PETTICOAT Technique for Aortic Dissection

et al. 2022

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Purpose: To report a unique case of bare metal stent migration in the overlapping zone and subsequent distal stent graft-induced new entry (SINE) after the Provisional Extension to Induce a Complete Attachment (PETTICOAT) technique for aortic dissection. Case report: A 67-year-old man underwent thoracic endovascular aortic repair (TEVAR) using the PETTICOAT technique for acute complicated type B aortic dissection. The postoperative course was uneventful, and follow-up computed tomography (CT) showed not only favorable aortic remodeling but also progressive bare metal stent migration in the overlapping zone between the stent graft and the bare metal stent. A 6-month postoperative CT revealed a distal SINE, and the patient underwent re-TEVAR to cover the new entry. Postoperative CT demonstrated successful repair of the distal SINE. The patient is currently in good health 2 years after the reintervention. Conclusion: Surgeons should consider the potential risk of device migration due to favorable aortic remodeling after TEVAR for aortic dissection, especially with the use of additional bare metal stents.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Unexpected Bare Metal Stent Migration Associated With Aortic Remodeling After PETTICOAT Technique for Aortic Dissection

et al. 2022

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“…2,38,39 However, reported studies have also suggested the loss of fixation and migration will result in increased movement of the graft and fatigue stress on the stent rings. 5,23 Aortic elongation will be more pronounced at the distal end of the thoracic aorta, 40,41 and the morphologic changes in the anatomy will affect the structural integrity of grafts. 2,4 Furthermore, angulation is a well-discussed risk factor for graft migration and a compromised seal.…”

Section: Discussionmentioning

confidence: 99%

A preliminary analysis of late structural failures of the Navion stent graft in the treatment of descending thoracic aortic aneurysms

Verzini

Cieri

Kahlberg

et al. 2021

Journal of Vascular Surgery

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Objective: Patients in the Valiant Evo U.S. and international clinical trials had positive short-term outcomes; however, late structural failures, including type IIIb endoleaks have been recently discovered. Type IIIb endoleaks are serious adverse events because the repressurization of the aneurysm sac increases the risk of rupture. The purpose of the present study was to detail the imaging patterns associated with the structural failures with the aim of increasing awareness of failing graft presentation, early recognition, and prompt treatment.Methods: The Valiant Evo clinical trial was a prospective, single-arm investigation of a thoracic stent graft system. With the recent late structural failures, sites were requested to submit all available imaging studies to date to allow the core laboratory to assess for structural failures such as type IIIb endoleaks, stent ring fractures, and stent ring enlargement. Of the 100 patients originally enrolled in the trial from 2016 to 2018, the core laboratory assessed the imaging studies performed at $1 year for 83 patients.Results: No structural failures of the graft were reported through 1 year of follow-up. At 1 to 4 years, graft structural failures were detected in 11 patients with descending thoracic aortic aneurysms. Of the 11 patients, 5 had a type IIIb endoleak. Four of the five had imaging findings showing stent fractures consistent with the location of the graft seam and one had a type IIIb endoleak attributed to calcium erosion with no stent fracture or ring enlargement. Of the four patients with stent fracture in line with the graft seam, three underwent a relining procedure that successfully excluded the type IIIb endoleak. One of these three patients died 4 days later of suspected thoracic aortic rupture because the distal thoracic endovascular aortic repair extension had been landed in a previously dissected and fragile section of the aorta. The remaining six patients had had stent ring enlargement. One of the six patients had had persistent aneurysm expansion from the time of implantation onward and had died of unknown causes. The remaining five patients have continued to be monitored. Conclusions:In the present preliminary analysis, the imaging patterns associated with type IIIb endoleaks, stent fractures, and stent ring enlargement appear to be related to the loss of seam integrity or detachment of the stent rings from the surface of the graft material. The imaging patterns we have detailed should be closely monitored using computed tomography angiography surveillance to allow structural failures to be promptly identified and treated.

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“…Migration has been commonly defined as having a movement of more than 5 or 10 mm between the stent graft tip and an anatomical landmark along the aorta [13,24]. If there was elongation of the aortic segment distal to the stent graft and proximal to the distal landmark, such as the celiac artery, the stent graft could be misclassified as migrating cranially [12]. Knowing the elongation is essential for correctly determining stent migration.…”

Section: Discussionmentioning

confidence: 99%

“…Reintervention was performed in 11.5% of type B dissections after TEVAR, for conditions such as stent graft-related complication [9]. While the rate of migration has been reported to be 4% [10], aortic elongation could interfere with the process of deciding whether there was migration of stent graft [11], and elongation could be mis-interpreted as stent graft migration [12].…”

Section: Introductionmentioning

confidence: 99%

Elongation of the Aorta after Thoracic Endovascular Aortic Repair: A longitudinal study

Chen

Chou

Chang

et al. 2020

IJERPH

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Aortic morphology is associated with age, with the diameter being larger in older people. Thoracic endovascular aortic repair (TEVAR) is a treatment for aortic diseases, such as aortic dissection. When evaluating patients, aortic elongation could interfere with the classification of TEVAR complications. The longitudinal change in aortic length has not been studied in detail. In patients receiving thoracic endovascular aortic repair between 2007 and 2013, we determined the aortic length between the sinotubular junction, left common carotid artery, subclavian artery, and celiac artery on their first five annual follow-up computed tomography (CT) exams. Using the immediate post-TEVAR follow-up CT as the comparison reference and a lengthening of the aortic segment by 10 mm or more as the definition of elongation, 16 of 41 (39%) showed elongation between the innominate artery and celiac artery. When compared with the immediate follow-up CT, a higher proportion of patients showed elongation at the fifth year’s follow-up CT than the first year’s follow-up CT (p < 0.01), and the average lengthening per year was 1.7 mm. There was progressive lengthening of the aorta after TEVAR.

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Thoracic endovascular aortic repair migration and aortic elongation differentiated using dual reference point analysis

Abstract: These results highlight the dynamic changes that can occur in the aorta as a natural consequence of age. Employing two landmarks can account for these changes and proves to be an important factor, among others, in the differentiation of aortic elongation from true stent graft migration.

Cited by 13 publications

References 21 publications

Unexpected Bare Metal Stent Migration Associated With Aortic Remodeling After PETTICOAT Technique for Aortic Dissection

Unexpected Bare Metal Stent Migration Associated With Aortic Remodeling After PETTICOAT Technique for Aortic Dissection

A preliminary analysis of late structural failures of the Navion stent graft in the treatment of descending thoracic aortic aneurysms

Elongation of the Aorta after Thoracic Endovascular Aortic Repair: A longitudinal study

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