Endograft migration after thoracic endovascular aortic repair

Background: Complications after thoracic endovascular aortic repair (TEVAR) are common. Even after a successful TEVAR, a late endoleak (>30 days) can occur. The objective of this study is to summarize the current evidence and, if lacking, the need of evidence regarding the incidence and predictive factors for type 1b endoleak in patients with aortic aneurysm treated with TEVAR. Methods: A systematic review of the literature was performed on endoleak type 1b, in patients with aortic aneurysm, after TEVAR. The PubMed and Embase databases were systematically searched for articles regarding endoleak type 1b up to January 2019. The main subjects discussed are the incidence, risk factors, treatment, and prognosis. Results: About 722 articles were screened, and 16 articles were included in this review. The reported incidence of endoleak is between 1.0% and 15.0%, with a mean follow-up duration of at least 1 year. Type 1b endoleak is associated with an increased aortic tortuosity index (>0.15 cm À1). No significant difference is found in relation to age and gender. Treatment is required in most cases (22/27) and is usually performed with distal extension of the stent graft (21/27). There are no data regarding stent graft oversizing, length of distal landing zone, and differences between devices or the prognosis for patients with type 1b endoleak. Conclusions: Limited literature is available on the occurrence of type 1b endoleak after TEVAR. A tortuous aorta can be associated as a predictive factor for the occurrence of type 1b endoleak. Data clearly delineating the anatomic variables predicting type 1b endoleak should be examined and listed. Likewise, the impact of more recent conformable devices to prevent complications like type 1b endoleaks from occurring should be elucidated.

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“…One type 1b endoleak resulted in death because of aneurysm rupture. 21 See also Table I for further specifications.…”

Section: Treatmentmentioning

confidence: 99%

Type 1b Endoleaks After Thoracic Endovascular Aortic Repair are Inadequately Reported: A Systematic Review

Belvroy

Beaufort

Herwaarden

et al. 2020

Annals of Vascular Surgery

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“…Finally, the distal seal has generally been discussed in the context of type Ib endoleaks. 2,38,39 However, reported studies have also suggested the loss of fixation and migration will result in increased movement of the graft and fatigue stress on the stent rings. 5,23 Aortic elongation will be more pronounced at the distal end of the thoracic aorta, 40,41 and the morphologic changes in the anatomy will affect the structural integrity of grafts.…”

Section: Discussionmentioning

confidence: 99%

A preliminary analysis of late structural failures of the Navion stent graft in the treatment of descending thoracic aortic aneurysms

Verzini

Cieri

Kahlberg

et al. 2021

Journal of Vascular Surgery

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Objective: Patients in the Valiant Evo U.S. and international clinical trials had positive short-term outcomes; however, late structural failures, including type IIIb endoleaks have been recently discovered. Type IIIb endoleaks are serious adverse events because the repressurization of the aneurysm sac increases the risk of rupture. The purpose of the present study was to detail the imaging patterns associated with the structural failures with the aim of increasing awareness of failing graft presentation, early recognition, and prompt treatment.Methods: The Valiant Evo clinical trial was a prospective, single-arm investigation of a thoracic stent graft system. With the recent late structural failures, sites were requested to submit all available imaging studies to date to allow the core laboratory to assess for structural failures such as type IIIb endoleaks, stent ring fractures, and stent ring enlargement. Of the 100 patients originally enrolled in the trial from 2016 to 2018, the core laboratory assessed the imaging studies performed at $1 year for 83 patients.Results: No structural failures of the graft were reported through 1 year of follow-up. At 1 to 4 years, graft structural failures were detected in 11 patients with descending thoracic aortic aneurysms. Of the 11 patients, 5 had a type IIIb endoleak. Four of the five had imaging findings showing stent fractures consistent with the location of the graft seam and one had a type IIIb endoleak attributed to calcium erosion with no stent fracture or ring enlargement. Of the four patients with stent fracture in line with the graft seam, three underwent a relining procedure that successfully excluded the type IIIb endoleak. One of these three patients died 4 days later of suspected thoracic aortic rupture because the distal thoracic endovascular aortic repair extension had been landed in a previously dissected and fragile section of the aorta. The remaining six patients had had stent ring enlargement. One of the six patients had had persistent aneurysm expansion from the time of implantation onward and had died of unknown causes. The remaining five patients have continued to be monitored. Conclusions:In the present preliminary analysis, the imaging patterns associated with type IIIb endoleaks, stent fractures, and stent ring enlargement appear to be related to the loss of seam integrity or detachment of the stent rings from the surface of the graft material. The imaging patterns we have detailed should be closely monitored using computed tomography angiography surveillance to allow structural failures to be promptly identified and treated.

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“…Riesterer et al stated that elongation could cause migration, [22]. A study comparing patients with and without stent graft migration, found that there was more elongation of the aorta [11]. Migration of the stent graft after TEVAR could cause an incomplete seal, and may cause complications, such as endoleak.…”

Section: Discussionmentioning

confidence: 99%

“…Reintervention was performed in 11.5% of type B dissections after TEVAR, for conditions such as stent graft-related complication [9]. While the rate of migration has been reported to be 4% [10], aortic elongation could interfere with the process of deciding whether there was migration of stent graft [11], and elongation could be mis-interpreted as stent graft migration [12].…”

Section: Introductionmentioning

confidence: 99%

“…The method for migration estimation proposed previously has stated that the aortic length should be stable before using a landmarked base measuring the distance between the stent graft and the anatomical landmark, for example, the distance along centerline of the aorta, between the left subclavian artery and celiac artery, should be stable before measuring and interpreting whether the stent has migrated or not [13]; a study has calculated the rate of migration using the above criteria, however, the duration between the follow-up CT and the operation was not clear [11]. It is not unclear how the aortic length would change in individuals in a long-term longitudinal follow-up study.…”

Section: Introductionmentioning

confidence: 99%

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Elongation of the Aorta after Thoracic Endovascular Aortic Repair: A longitudinal study

Chen

Chou

Chang

et al. 2020

IJERPH

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Aortic morphology is associated with age, with the diameter being larger in older people. Thoracic endovascular aortic repair (TEVAR) is a treatment for aortic diseases, such as aortic dissection. When evaluating patients, aortic elongation could interfere with the classification of TEVAR complications. The longitudinal change in aortic length has not been studied in detail. In patients receiving thoracic endovascular aortic repair between 2007 and 2013, we determined the aortic length between the sinotubular junction, left common carotid artery, subclavian artery, and celiac artery on their first five annual follow-up computed tomography (CT) exams. Using the immediate post-TEVAR follow-up CT as the comparison reference and a lengthening of the aortic segment by 10 mm or more as the definition of elongation, 16 of 41 (39%) showed elongation between the innominate artery and celiac artery. When compared with the immediate follow-up CT, a higher proportion of patients showed elongation at the fifth year’s follow-up CT than the first year’s follow-up CT (p < 0.01), and the average lengthening per year was 1.7 mm. There was progressive lengthening of the aorta after TEVAR.

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Endograft migration after thoracic endovascular aortic repair

Cited by 26 publications

References 30 publications

Type 1b Endoleaks After Thoracic Endovascular Aortic Repair are Inadequately Reported: A Systematic Review

Type 1b Endoleaks After Thoracic Endovascular Aortic Repair are Inadequately Reported: A Systematic Review

A preliminary analysis of late structural failures of the Navion stent graft in the treatment of descending thoracic aortic aneurysms

Elongation of the Aorta after Thoracic Endovascular Aortic Repair: A longitudinal study

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