Endograft Migration: Incidence, Causes, and Clinical Significance

Abstract

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.