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

2002 ◽  
Vol 9 (5) ◽  
pp. 652-664 ◽  
Author(s):  
James T. Lee ◽  
Jason Lee ◽  
Ihab Aziz ◽  
Carlos E. Donayre ◽  
Irwin Walot ◽  
...  
Keyword(s):  
Risk Factors ◽  
Stent Graft ◽  
Endovascular Repair ◽  
Graft Migration

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

2002 ◽  
Vol 9 (5) ◽  
pp. 652-664 ◽  
Author(s):  
James T. Lee ◽  
Jason Lee ◽  
Ihab Aziz ◽  
Carlos E. Donayre ◽  
Irwin Walot ◽  
...  
Keyword(s):  
Stent Graft ◽  
Endovascular Repair ◽  
Morphological Changes ◽  
Morphological Characteristics ◽  
Anatomical Characteristic ◽  
Computed Tomographic ◽  
Aortic Neck ◽  
Distal Migration ◽  
Graft Migration ◽  
Over Time

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.

Functional Endoluminal Paving (FELP): Thermoforming, Biodegradation, and Mechanical Properties of a Novel Polymer Graft for Abdominal Aortic Aneurysms

2010 ◽  
Author(s):  
John H. Ashton ◽  
James A. M. Mertz ◽  
Megan J. Alexander ◽  
Marvin J. Slepian ◽  
Joseph L. Mills ◽  
...  
Keyword(s):  
Mechanical Properties ◽  
Stent Graft ◽  
Endovascular Repair ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Complex Anatomy ◽  
Abdominal Aortic ◽  
Drug Treatments

The preferred method to treat abdominal aortic aneurysms (AAAs) is endovascular repair with a stent-graft (EVAR). Although EVAR is fairly successful, there are several challenges to address, which include patient ineligibility due to complex anatomy and long-term failure due to migration and endoleak. Drug treatments that reduce or halt AAA growth are also currently under investigation [1].

Healing Response of Normal Canine Aorta and Iliac Artery to a Nitinol Stent Encapsulated in Carbon-Lined ePTFE

2001 ◽  
Vol 8 (3) ◽  
pp. 274-281 ◽  
Author(s):  
Jonathan D. Woody ◽  
Gary Nishanian ◽  
George E. Kopchok ◽  
Nam I.I. Kim ◽  
Carlos E. Donayre ◽  
...  
Keyword(s):  
Stent Graft ◽  
Iliac Artery ◽  
Endothelial Lining ◽  
Nitinol Stent ◽  
Healing Response ◽  
Novel Approach ◽  
Group 2 ◽  
Graft Migration ◽  
Implanted Devices

Purpose: To evaluate the healing response of normal canine arteries to a self-expanding nitinol stent encapsulated in carbon-lined expanded polytetrafluoroethylene (ePTFE). Methods: Twenty-eight dogs were divided into aortic (n = 18) or iliac (n = 10) groups. In the latter, 2 animals were assigned to implantation intervals of 7, 30, and 90 days, respectively; 4 were designated for 180-day implantation. Half of the animals in each subgroup received a second overlapping stent-graft in one iliac artery. In the aortic cohort, 6 animals were assigned to the 180-day implantation group (2 with dual devices) and 3 to each of the others (1 dual implantation in each group). The devices were evaluated with angiography and intravascular ultrasound at implantation and explantation. After harvesting and gross examination, the specimens were examined microscopically and with scanning electron microscopy. Results: The 49 implanted devices (24 aortic and 25 common iliac) were all widely patent at explantation, save for 2 iliac stents that had moderate (<40%) stenosis. No neointima was present at the 7-day interval. All stents were covered by thin neointima (<150 µm) at 30 days. At 180 days, an endothelial lining was present in the proximal and distal segments of all stents; in 4 of the 6 aortic stents, this endothelial lining was complete, whereas none of the iliac devices had endothelium in the midsegment at 180 days. At 1 year, 2 of the aortic specimens had an incomplete endothelial lining, whereas the lining was complete in the third. There was no evidence of stent-graft migration or inflammation associated with any device. Conclusions: The carbon-lined ePTFE-encapsulated stent is a novel approach to arterial stenting. The progressive endothelialization and lack of inflammatory reaction may provide improved long-term patency. Further study of this stent-graft design is warranted.

scholarly journals Risk factors for distal stent graft-induced new entry tear after endovascular repair of thoracic aortic dissection

2019 ◽  
Vol 69 (5) ◽  
pp. 1610-1614 ◽  
Author(s):  
Ludovic Canaud ◽  
Thomas Gandet ◽  
Julien Sfeir ◽  
Baris Ata Ozdemir ◽  
Laurence Solovei ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Dissection ◽  
Stent Graft ◽  
Endovascular Repair ◽  
Thoracic Aortic Dissection ◽  
New Entry

P5603Distal stent graft induced new entry: risk factors in acute and chronic type B aortic dissections

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Lortz ◽  
F Leinburger ◽  
K Tsagakis ◽  
C Rammos ◽  
A Lind ◽  
...  
Keyword(s):  
Risk Factors ◽  
Stent Graft ◽  
Rare Complication ◽  
Stent Grafts ◽  
Long Term Outcome ◽  
Acute Dissection ◽  
Predicting Factor ◽  
New Entry

Abstract Background Distal stent graft induced new entry (dSINE) is a rare complication occurring in acute and chronic dissections after thoracic endovascular aortic repair (TEVAR) and is linked to a high reintervention rate. We analyzed potential predicting risk factors for dSINE and analyzed the long-term outcome in patients after reintervention. Methods In this single-center, retrospective study we evaluated patients after TEVAR and investigated possible predictors for dSINE development. Therefore, we used a multivariate analysis to test important interventional parameters such as distal oversizing (dOS), taper ratio (TR), angle between distal stent graft and aorta, acute dissection and stent graft length. Reinterventional characteristics were analyzed and further long-term follow-ups after reintervention evaluated. Results We analyzed 185 patients with acute (n=77) and chronic (n=108) dissections after TEVAR with a follow-up of 68.9±32.5 months. Within the follow-up period, 12 (6.5%) patients developed dSINE after a median time of 22.2±20.7 months. We identified acute dissection as a major predicting factor for dSINE development with a 15.8 times higher odds, followed by an increased dOS and TR. The reintervention rate was higher in the dSINE group (83% vs. 20%, p=0.001), but reinterventional results were mostly satisfying, including further freedom from reintervention and/or new endoleak development up to a mean follow-up of 60.7±54.8 months. No dSINE was seen in association to tapered stent grafts. Conclusion We found acute aortic dissection as a major predicting factor for dSINE development, followed by increased dOS and TR. The use of tapered stent grafts might be beneficial in cases with expected high dOS and TR. In rare cases with dSINE occurrence, reintervention is often required, but has a good prognosis even after years.

Early- and long-term results of thoracic endovascular aortic repair for blunt traumatic thoracic aortic injury: a single-centre experience†

2019 ◽  
Vol 56 (2) ◽  
pp. 307-312
Author(s):  
Daisuke Kaneyuki ◽  
Toshihisa Asakura ◽  
Atsushi Iguchi ◽  
Akihiro Yoshitake ◽  
Chiho Tokunaga ◽  
...  
Keyword(s):  
Stent Graft ◽  
Endovascular Repair ◽  
Aortic Injury ◽  
Long Term Results ◽  
Technical Success Rate ◽  
Thoracic Aortic Injury ◽  
Cord Injury ◽  
Long Term Follow Up

Abstract OBJECTIVES Endovascular repair has been proposed as an alternative to classical surgical repair for the management of blunt traumatic thoracic aortic injury. However, the long-term outcomes of endovascular repair and the risks of left subclavian coverage remain unclear. METHODS From April 2001 to August 2018, 33 patients with blunt traumatic thoracic aortic injury underwent endovascular repair in our institution. A follow-up computed tomography and a clinical examination were performed before discharge and at 1 month, and yearly or every 2 years thereafter. RESULTS The mean age was 45 ± 19 years. The technical success rate was 100%. Complete coverage of the left subclavian artery (LSCA) was performed in 20 patients (60.6%). Among 20 patients with coverage of the LSCA, revascularization was performed in 1 patient. No in-hospital deaths occurred. The clinical follow-up rate was 97%, with a mean period of 7 years and a maximum of 18 years. The survival rates were 100% at 1 year, 95% at 5 years and 88.7% at 10 years after the event. Among the 5 patients (20%) who developed neurological complications, 1 who had undergone implantation of a 200-mm long stent graft and LSCA coverage without revascularization developed paraplegia during the long-term follow-up. CONCLUSIONS This study demonstrates that the endovascular treatment of blunt traumatic thoracic aortic injury is a safe and effective therapeutic method over a long-term follow-up period. LSCA coverage and long stent graft placement might be indications for revascularization to prevent spinal cord injury.

Stent-Graft Migration After Endovascular Repair of Abdominal Aortic Aneurysm

2002 ◽  
Vol 9 (6) ◽  
pp. 743-747 ◽  
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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