Stent-Graft Migration following Endovascular Repair of Aneurysms with Large Proximal Necks: Anatomical Risk Factors and Long-term Sequelae

Purpose: To evaluate the outcome of aortic endografts deployed in large infrarenal necks and to identify any association of preoperative aneurysm characteristics and postoperative morphological changes with the incidence of neck dilatation and device migration in this patient subset. Methods: The records of 47 patients (41 men; mean age 74, range 55–84) with large aortic neck diameters treated with Talent stent-grafts from 1998 to 2001 were reviewed. Patients with anatomical criteria that precluded aneurysm exclusion with currently available devices were preferentially selected. Mean baseline aneurysm morphology included 27.6-mm (range 18–33.4) suprarenal and 28.1-mm (range 24–34) infrarenal neck diameters; the infrarenal neck length was 26 ± 16 mm with angulation of 37° ± 18°. Computed tomographic (CT) angiograms up to 3 years were analyzed using specialized interactive software; migration was defined as >1-cm change in the distance from the lower renal artery to the top of the device. Pre- and postoperative morphological characteristics of the aneurysm were compared between patients with and without migration. Results: Of the 45 patients successfully treated, 40 had complete CT data for analysis. During a mean 17-month follow-up, 7 (17.5%) of the 40 devices exhibited distal migration. Six patients required secondary procedures; 5 were in the migration cohort. No preoperative anatomical characteristic or degree of neck dilatation over time was predictive of stent-graft migration. Aneurysm sac regression was significant at 1 (–0.09 ± 4.90 mm) and 2 (–1.48 ± 2.56 mm) years in endografts without migration (p<0.001). Distal endograft migration >1 cm predicted the need for secondary interventions (p<0.001), with 83% sensitivity and 94% specificity. Conclusions: Endovascular repair is successful in patients with large infrarenal necks and complex neck morphology. Changes in aneurysm remodeling over time were similar to reported observations in patients with more favorable neck criteria. Although no anatomical factor associated with migration could be identified from this analysis, distal displacement >1 cm correlated with the need for a secondary intervention.

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Eligibility Rates of Ruptured and Symptomatic AAA for Endovascular Repair

Journal of Endovascular Therapy ◽

10.1177/152660280200900409 ◽

2002 ◽

Vol 9 (4) ◽

pp. 436-442 ◽

Cited By ~ 19

Author(s):

W. Anthony Lee ◽

Thomas S. Huber ◽

Christa M. Hirneise ◽

Scott A. Berceli ◽

James M. Seeger

Keyword(s):

Endovascular Repair ◽

Care Center ◽

Tertiary Care ◽

Aortic Aneurysms ◽

Ct Scans ◽

Asymptomatic Group ◽

Proximal Neck ◽

Computed Tomographic ◽

Aortic Neck ◽

Elective Repair

Purpose: To determine the anatomical eligibility rate for endovascular repair of ruptured and symptomatic abdominal aortic aneurysms (AAA) using commercially available endografts. Methods: In a retrospective review, 28 preoperative computed tomographic (CT) scans were examined from among 83 patients who underwent surgical repair of a ruptured or acutely symptomatic AAA at a university-based tertiary care center during the past 10 years. The proximal aortic neck, aneurysm, and iliac dimensions were compared to corresponding measurements from 100 preoperative CT scans from patients who underwent elective repair of asymptomatic AAA. Based on expanded selection criteria for the 2 FDA-approved endografts (AneuRx and Ancure), eligibility rates for endovascular repair were compared between patients with ruptured/symptomatic and asymptomatic AAAs. Results: The proximal neck of the ruptured/symptomatic AAAs was on the average 2 mm larger in diameter (25 ± 4 versus 23 ± 3 mm, p=0.04) and 7 mm shorter (16 ± 10 versus 23 ± 14, p=0.017) than asymptomatic AAAs. The maximum AAA diameter was significantly larger in the ruptured/symptomatic group (64 ± 16 mm) than in the asymptomatic group (58 ± 11 mm, p=0.033). Of the 28 ruptured/symptomatic AAAs assessed morphologically, 13 (46%) were anatomically eligible for endovascular repair compared to 74 of the 100 asymptomatic AAAs (p=0.006). The main cause for exclusion was an unfavorable proximal neck, which was present in 15 (54%) of the 28 ruptured/symptomatic AAAs and in 24 (24%) of the 100 asymptomatic AAAs (p = 0.003). Conclusions: A significantly smaller proportion of patients presenting with ruptured/symptomatic AAA are anatomically eligible for endovascular AAA repair compared to patients with asymptomatic AAA due to unfavorable proximal neck anatomy.

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Midterm Outcome of EndoAnchors for the Prevention of Endoleak and Stent-Graft Migration in Patients With Challenging Proximal Aortic Neck Anatomy

Journal of Endovascular Therapy ◽

10.1177/1526602815574685 ◽

2015 ◽

Vol 22 (2) ◽

pp. 163-170 ◽

Cited By ~ 31

Author(s):

William D. Jordan ◽

Jean-Paul P. M. de Vries ◽

Kenneth Ouriel ◽

Manish Mehta ◽

David Varnagy ◽

...

Keyword(s):

Stent Graft ◽

Midterm Outcome ◽

Aortic Neck ◽

Neck Anatomy ◽

Graft Migration

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Aortic neck evolution after endovascular repair with TriVascular Ovation stent graft

Journal of Vascular Surgery ◽

10.1016/j.jvs.2015.07.099 ◽

2016 ◽

Vol 63 (1) ◽

pp. 8-15 ◽

Cited By ~ 39

Author(s):

Gianmarco de Donato ◽

Francesco Setacci ◽

Luciano Bresadola ◽

Patrizio Castelli ◽

Roberto Chiesa ◽

...

Keyword(s):

Stent Graft ◽

Endovascular Repair ◽

Aortic Neck

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Thrombotic Occlusion of Stent Graft Limbs due to Severe Angulation of Aortic Neck in Endovascular Repair of Abdominal Aortic Aneurysm

Korean Circulation Journal ◽

10.4070/kcj.2016.46.5.727 ◽

2016 ◽

Vol 46 (5) ◽

pp. 727 ◽

Cited By ~ 3

Author(s):

Minsu Kim ◽

Myeong Gun Kim ◽

Woong Chol Kang ◽

Pyung Chun Oh ◽

Ji Yeon Lee ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Stent Graft ◽

Endovascular Repair ◽

Thrombotic Occlusion ◽

Aortic Neck ◽

Abdominal Aortic

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Endovascular Repair of Traumatic Descending Aortic Transection

Journal of Endovascular Therapy ◽

10.1177/152660280200900503 ◽

2002 ◽

Vol 9 (5) ◽

pp. 573-578 ◽

Cited By ~ 47

Author(s):

Karl Heinz Orend ◽

Reinhard Pamler ◽

Xaver Kapfer ◽

Florian Liewald ◽

Johannes Görich ◽

...

Keyword(s):

Stent Graft ◽

Endovascular Repair ◽

Neurological Deficit ◽

Traffic Accidents ◽

Aortic Rupture ◽

Ct Scans ◽

Type I ◽

Computed Tomographic ◽

Aortic Transection ◽

Permanent Neurological Deficit

Purpose: To present the results of endovascular repair of acute traumatic descending aortic transection. Methods: Among 66 thoracic stent-graft repairs performed between 1995 and 2001, 11 patients (9 men; mean age 34 years, range 12–73) underwent emergent endovascular repair of acute traumatic descending aortic transection following traffic accidents. Immediate treatment of aortic rupture was indicated in all patients because of a marked fresh hematoma with hemothorax; the spiral computed tomographic (CT) scans showed circular or semicircular descending thoracic aortic injuries. The devices used included 11 thoracic Excluders and 1 Talent stent-graft. Results: No patient required conversion to an open transthoracic operation. No patient developed temporary or permanent neurological deficit after endovascular treatment. Two type I endoleaks required periprocedural treatment: a second stent-graft was deployed in one and the existing stent-graft was balloon dilated in the other. Two patients underwent secondary procedures (iliac access complication and revascularization of the left subclavian artery). One patient died 22 days postoperatively secondary to injuries unrelated to the aortic repair. Over a mean 14-month follow-up (range 1–26), the surveillance CT scans have shown the stent-graft to be correctly positioned in all patients. Conclusions: The treatment of acute traumatic descending aortic transection with an endovascular approach is feasible and safe and may offer the best means of therapy. Mortality and the risk of neurological deficit are low compared with open operations.

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Stent-Graft Migration After Endovascular Repair of Abdominal Aortic Aneurysm

Journal of Endovascular Therapy ◽

10.1583/1545-1550(2002)009<0743:sgmaer>2.0.co;2 ◽

2002 ◽

Vol 9 (6) ◽

pp. 743-747 ◽

Cited By ~ 4

Author(s):

Stavros Kalliafas ◽

Jean-Noel Albertini ◽

Jan Macierewicz ◽

Syed W. Yusuf ◽

Simon C. Whitaker ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Stent Graft ◽

Endovascular Repair ◽

Abdominal Aortic ◽

Graft Migration

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Stent-Graft Migration Following Endovascular Repair of Aneurysms With Large Proximal Necks: Anatomical Risk Factors and Long-term Sequelae

Journal of Endovascular Therapy ◽

10.1583/1545-1550(2002)009<0652:sgmfer>2.0.co;2 ◽

2002 ◽

Vol 9 (5) ◽

pp. 652-664 ◽

Cited By ~ 37

Author(s):

James T. Lee ◽

Jason Lee ◽

Ihab Aziz ◽

Carlos E. Donayre ◽

Irwin Walot ◽

...

Keyword(s):

Risk Factors ◽

Stent Graft ◽

Endovascular Repair ◽

Graft Migration

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Aortic Neck Dilatation and Graft Migration after Endovascular Aneurysm Repair with the Ovation Stent Graft

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2020.07.690 ◽

2020 ◽

Vol 231 (4) ◽

pp. S341

Author(s):

Asma Mathlouthi ◽

Andrew Barleben ◽

Rebecca Ann Marmor ◽

Hanaa Dakour-Aridi ◽

Omar Al-Nouri ◽

...

Keyword(s):

Stent Graft ◽

Endovascular Aneurysm Repair ◽

Aortic Neck ◽

Aneurysm Repair ◽

Graft Migration

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Midterm Results of Proximal Aneurysm Sealing With the Ovation Stent-Graft According to On- vs Off-Label Use

Journal of Endovascular Therapy ◽

10.1177/1526602816685581 ◽

2017 ◽

Vol 24 (2) ◽

pp. 191-197 ◽

Cited By ~ 21

Author(s):

Gianmarco de Donato ◽

Francesco Setacci ◽

Luciano Bresadola ◽

Patrizio Castelli ◽

Roberto Chiesa ◽

...

Keyword(s):

Stent Graft ◽

Morphological Changes ◽

Endovascular Aneurysm Repair ◽

Neck Length ◽

Off Label ◽

Aortic Neck ◽

Type Ia ◽

Instructions For Use ◽

Aneurysm Repair

Purpose: To compare the use of the Ovation stent-graft according to the ≥7-mm neck length specified by the original instructions for use (IFU) vs those treated off-label (OL) for necks <7 mm long. Methods: A multicenter retrospective registry (TriVascular Ovation Italian Study) database of all patients who underwent endovascular aneurysm repair with the Ovation endograft at 13 centers in Italy was interrogated to identify patients with a minimum computed tomography (CT) follow-up of 24 months, retrieving records on 89 patients (mean age 76.4±2.4 years; 84 men) with a mean follow-up of 32 months (range 24–50). Standard CT scans (preoperative, 1-month postoperative, and latest follow-up) were reviewed by an independent core laboratory for morphological changes. For analysis, patients were stratified into 2 groups based on proximal neck length ≥7 mm (IFU group, n=57) or <7 mm (OL group, n=32). Outcome measures included freedom from type Ia endoleak, any device-related reintervention, migration, and neck enlargement (>2 mm). Results: At 3 years, there was no aneurysm-related death, rupture, stent-graft migration, or neck enlargement. There were no differences in terms of freedom from type Ia endoleak (98.2% IFU vs 96.8% OL, p=0.6; hazard ratio [HR] 0.55, 95% CI 0.02 to 9.71 or freedom from any device-related reintervention (92.8% IFU vs 96.4% OL, p=0.4; HR 2.42, 95% CI 0.34 to 12.99). In the sealing zone, the mean change in diameters was −0.05±0.8 mm in the IFU group and −0.1±0.5 mm in the OL group. Conclusion: Use of the Ovation stent-graft in patients with neck length <7 mm achieved midterm outcomes similar to patients with ≥7-mm-long necks. These midterm data show that the use of the Ovation system for the treatment of infrarenal abdominal aortic aneurysm is not restricted by the conventional measurement of aortic neck length, affirming the recent Food and Drug Administration–approved changes to the IFU.

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