Device migration after endoluminal abdominal aortic aneurysm repair: Analysis of 113 cases with a minimum follow-up period of 2 years

Cao, Piergiorgio; Verzini, Fabio; Zannetti, Simona; Rango, Paola De; Parlani, Gianbattista; Lupattelli, L; Maselli, A

doi:10.1067/mva.2002.120045

Cited by 153 publications

(142 citation statements)

References 26 publications

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“…Greater degrees of endograft curvature will result in significantly larger forces applied to the endograft. While clinical endograft migration is usually described as longitudinal or caudal migration, 3,24,25 image analysis often reveals significant lateral movement of the endograft, as depicted in Figure 8. The 5.5-cm aneurysm was treated with an endograft, and postimplantation computed tomography (CT) showed good position of the endograft with complete aneurysm exclusion and no endoleak.…”

Section: Discussionmentioning

confidence: 99%

Effect of Curvature on Displacement Forces Acting on Aortic Endografts: A 3-Dimensional Computational Analysis

Figueroa

Taylor

Yeh

et al. 2009

Journal of Endovascular Therapy

112

114

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¤ ¤Purpose: To determine the effect of curvature on the magnitude and direction of displacement forces acting on aortic endografts in 3-dimensional (3D) computational models.Method: A 3D computer model was constructed based on magnetic resonance angiography data from a patient with an infrarenal aortic aneurysm. Computational fluid dynamics tools were used to simulate realistic flow and pressure conditions of the patient. An aortic endograft was deployed in the model, and the displacement forces acting on the endograft were calculated and expressed in Newtons (N). Additional models were created to determine the effects of reducing endograft curvature, neck angulation, and iliac angulation on displacement forces. Results: The aortic endograft had a curved configuration as a result of the patient's anatomy, with curvature in the anterolateral direction. Total displacement force acting on the endograft was 5.0 N, with 28% of the force in a downward (caudal) direction and 72% of the force in a sideways (anterolateral) direction. Elimination of endograft curvature (planar graft configuration) reduced total displacement force to 0.8 N, with the largest component of force (70%) acting in the sideways direction. Straightening the aortic neck in the curved endograft configuration reduced the total force acting on the endograft to 4.2 N, with a reduction of the sideways component to 55% of the total force. Straightening the iliac limbs of the endograft reduced the total force acting on the endograft to 2.1 N but increased the sideways component to 91% of the total force. Conclusion: The largest component of the force acting on the aortic endograft is in the sideways direction, with respect to the blood flow, rather than in the downward (caudal) direction as is commonly assumed. Increased curvature of the aortic endograft increases the magnitude of the sideways displacement force. The degree of angulation of the proximal and distal ends of the endograft influence the magnitude and direction of displacement force. These factors may have a significant influence on the propensity of endografts to migrate in vivo.

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Section: Discussionmentioning

confidence: 99%

Effect of Curvature on Displacement Forces Acting on Aortic Endografts: A 3-Dimensional Computational Analysis

Figueroa

Taylor

Yeh

et al. 2009

Journal of Endovascular Therapy

112

114

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“…In addition, the possibility of endoleak and/or migration in the future cannot be ruled out because the number of patients in this study was small and the follow-up period was short. 56,57 …”

Section: Discussionmentioning

confidence: 99%

Initial and Midterm Results for Repair of Aortic Diseases With Handmade Stent Grafts

Onitsuka

Tanaka

Akashi

et al. 2006

Circ J

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“…Thus, it is not surprising that migration has been noted with all current endovascular devices and configurations, including those with modular design, unibody design, infrarenal fixation, suprarenal fixation, hook and barb fixation, longitudinal columnar support, and flexible designs. [4][5][6][7][8][9][10] Migration has also been noted with prosthetic aortic grafts placed at open surgery. The risk of migration increases with time and can result in the loss of device fixation proximally, dis-tally, or at modular junctions, resulting in aneurysm rupture.…”

Section: Introductionmentioning

confidence: 99%

“…Unfortunately, the reported incidence of endograft migration varies widely between studies, and this may be due to different definitions of endograft migration and the follow-up period may vary. 4 …”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] However, the migration of endoluminal devices has been noted following successful endovascular repair, raising concerns about long-term durability of endovascular repair. [4][5][6] Continuous downward displacement forces are exerted on all aortic devices by the pulsatile nature of blood flow, with cumulative effects over time. Thus, it is not surprising that migration has been noted with all current endovascular devices and configurations, including those with modular design, unibody design, infrarenal fixation, suprarenal fixation, hook and barb fixation, longitudinal columnar support, and flexible designs.…”

Section: Introductionmentioning

confidence: 99%

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Endograft Migration: Incidence, Causes, and Clinical Significance

Lee

Zarins

2004

Perspectives in Vascular Surgery and Endovascular Therapy

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Endovascular device migration is approximately 2% at 1 year using each of the Food and Drug Administration-approved devices (Medtronic AneuRx, Gore Excluder, Cook Zenith). In this report, we review the incidence, causes, and clinical importance of endograft migration over a 5-year period after endovascular aneurysm repair with the AneuRx stent graft. In a multicenter United States clinical trial of the AneuRx device, migration was identified in 8% (94/1119) of patients over a mean follow up time of 30 ± 11 months. A Kaplan-Meier analysis determined migration rates were 1.4% at 1 year, 6.6% at 2 years, and 18.8% at 3 years. The significant factors in device migration appeared to be proximal fixation length (P = .005), renal artery to stent-graft distance (P = .001), and the clinical site (P < .001). Preimplantation aortic neck length, neck diameter, degree of device oversizing, device type (stiff vs flexible), placement of proximal extender cuffs at the original procedure, and postprocedure endoleak were not significant predictors of migration. These results highlight the importance of technical precision in stent-graft deployment as critical in preventing late AneuRx stent graft migration.

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Device migration after endoluminal abdominal aortic aneurysm repair: Analysis of 113 cases with a minimum follow-up period of 2 years

Cited by 153 publications

References 26 publications

Effect of Curvature on Displacement Forces Acting on Aortic Endografts: A 3-Dimensional Computational Analysis

Effect of Curvature on Displacement Forces Acting on Aortic Endografts: A 3-Dimensional Computational Analysis

Initial and Midterm Results for Repair of Aortic Diseases With Handmade Stent Grafts

Endograft Migration: Incidence, Causes, and Clinical Significance

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