A Rare Complication After Endovascular Aneurysm Repair

Abstract

After publication of a few such cases with the older Zenith device, the union between the suprarenal stent and main body was reinforced in 2002 to prevent this complication. Since modification of the device, this sequela had not been described. The reappearance of this complication underscores the need for continued surveillance, considering that these late events may require a reintervention to maintain the clinical success of the procedure.

Zenith AAA endovascular graft suprarenal bare metal stent separation with graft migration and type IA endoleak

“…1,[6][7][8] On further review, however, several cases have also been reported in devices inserted after design modification. Torres-Blanco et al ( 2016) reported two cases of suprarenal stent disconnection in Zenith devices inserted in 2006, 9 and Lindstrom et al ( 2016) reported two cases in devices inserted in 2011 and 2012, respectively. 10 Thus, whilst device modification may have strengthened this area of the stent graft, there remains cases of weakness and separation at this point.…”

“…This patient was however noted to have a short aneurysm neck, an anatomical factor identified in previously reported cases of separation. 6,[8][9][10] While the patient's past history of thrombectomy soon after the index procedure is relevant, as instrumentation may have exerted significant tractional forces on the graft and its attachments, normal surveillance imaging multiple years after this intervention indicates that this did not compromise the graft.…”

Repair of a late endoleak following complete proximal endograft fixation strut separation

“…In 2002, double suturing was implemented by the manufacturer to increase stability between the main body and uncovered segment. 10 , 11 , 12 As EVAR has superseded open aortic repair for aneurysmal disease, device failure has become more commonly reported. A major contributing factor to failed EVAR devices are their use beyond the advised instructions for use, a practice that has been largely supported by the literature to result in higher rates of device failure.…”