Absence of proximal neck dilatation and graft migration after endovascular aneurysm repair with balloon-expandable stent-based endografts

Abstract

Neither PND nor endograft migration was observed with the BES endograft. The nature of the SES may be responsible for the observed neck dilatation and device migration after EVAR with SES endografts. This study suggests that BES may be a better fixation method for EVAR.

Aortic neck evolution after endovascular repair with TriVascular Ovation stent graft

“…Careful measurement of the proximal neck showed that neck dilation did not take place with the Parodi endograft. 18 In an early experience with the Montefiore endograft system, which is a balloon-expandable stent graft (BESG), Malas et al 19 reported neither neck evolution nor endograft migration at a mean follow-up of 31 months in a series of 77 patients. Also, second-generation BESGs revealed a migration rate of 0%.…”

Aortic neck enlargement after endovascular aneurysm repair using balloon-expandable versus self-expanding endografts

“…37,38 Long-term follow-up of patients treated with the Parodi BES device showed no evidence of neck enlargement. 18 Similarly, Malas et al 19 found no evidence of neck enlargement (62.5 mm) among 41 patients treated with a BES endograft on follow-up CT scans at a mean of 31 months (range, 15 years). Neck enlargement of 1 to 2 mm was noted in 17% of these patients and is consistent with the expected age-related increase in size.…”

“…13 Neck enlargement has been related to the degree of stent graft oversizing at the time of implantation 7,14,15 and has been implicated in device migration and the development of new-onset type I endoleaks. 5,11,12,16,17 Although absence of aortic neck dilatation has been reported in patients treated with balloonexpandable stent (BES) grafts, 18,19 systematic reviews have found no clear association between neck dilation and SES grafts 15 and have concluded that aortic neck dilation is most probably an expression of ongoing aneurysm wall degeneration of the infrarenal aortic segment. 20 The Nellix device (Endologix, Irvine, Calif), a novel endograft that uses BESs rather than SESs, along with polymer-filled endobags, to achieve fixation and seal of the aneurysm sac, has experienced favorable early clinical results.…”

Endovascular Aneurysm Repair of Abdominal Aortic Aneurysms: Standards, Technical Options and Advanced Indications

“…Pathophysiologically speaking, the aortic wall is subjected to radial forces in the region of the proximal landing zone due to the deployment force of the endovascular prosthesis. If the radial force of the stent graft is greater than the recoil of the elastic aortic wall, the treated aneurysm neck dilates with the risk of a type I endoleak or prosthesis migration [65] primarily in the long-term course after initial implantation. Commercially available endostapling devices (e. g. Aptus Endovascular AAA Repair System) allow subsequent fixation of the endovascular prosthesis to the aortic wall using helix screws that are screwed into the prosthesis/aortic wall via a specific system to prevent longitudinal migration and to reduce rotation forces [66].…”