Factors and Forces Influencing Stent-Graft Migration after Endovascular Aortic Aneurysm Repair

Mohan, Irwin V.; Harris, Peter L.; Marrewijk, C.J. van; Laheij, R.J.F.; How, T.V.

doi:10.1177/152660280200900606

Cited by 92 publications

(97 citation statements)

References 15 publications

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“…Forces acting at the proximal landing zones are greater than those in at the distal landing and are in an opposite direction [15]. The length of coverage of the common iliac artery is a potential factor in preventing distal stent-graft migration into the aneurysm sac [16].…”

Section: Discussionmentioning

confidence: 99%

Migration of the Nellix endoprosthesis

England

Torella

Fisher

et al. 2016

Journal of Vascular Surgery

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PURPOSE: To report the incidence and sequelae of migration of the Nellix® endoprothesis following endovascular aneurysm sealing (EVAS).METHOD: A review was performed of the follow-up imaging of all EVAS patients in a University Hospital endovascular programme who had a minimum follow-up of one year. Using the first post-operative and latest follow-up CT scans, the distances between the proximal and distal borders of the stent-grafts relative to reference vessels were measured using a previously validated technique. Device migration was based on previously established criteria and defined as any stent-graft movement of ≥ 4 mm related to a predefined reference vessel. Device movement in a caudal direction was given a positive value (+) whereas movement in a cranial direction was denoted by a negative sign (-).RESULTS: 18 patients (35 stent-grafts) were eligible for inclusion in this retrospective review.The mean (SD; range) pre-operative AAA diameter and aortic neck length were 57 (5; 50 to 67) mm and 30 (16; 6 to 62) mm, respectively. Proximal migration, according to study definitions, was identified in six stent-grafts (17%), all in a caudal direction. At one year the mean (SD; range) proximal migration distance was +6.6 (1.6; +4.7 to +9.2) mm. Migration occurred in a single stent-graft in four patients and bilaterally in one. Distally, there were no cases of migration.CONCLUSIONS: Proximal migration of the Nellix® endoprosthesis does occur and in our series was without any sequelae. Further investigations into the long-term positional stability of the Nellix® device are required together with a more thorough understanding of the aetiology and consequences of migration.

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Section: Discussionmentioning

confidence: 99%

Migration of the Nellix endoprosthesis

England

Torella

Fisher

et al. 2016

Journal of Vascular Surgery

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“…The latter constitutes a rather common incidental finding, occurring more frequently that previously assumed (Wu et al, 2009). Finally, the study and understanding of the hemodynamic alterations and the parameters that influence them, could lead to better designs of endovascular grafts, in order to eliminate the factors that predispose to endograft migration as well as to generation of endoleaks (Figueroa 2009and 2010, Liffman 2001, Mohan 2002). …”

Section: Discussionmentioning

confidence: 99%

Studying the Flow Dynamics Within Endografts in Abdominal Aortic Aneurysms

Georgakarakos¹,

Xenakis²,

Georgiadis³

et al. 2012

Aneurysm

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“…The trends identified by CFD studies as factors contributing to increased displacement force (e.g., increased proximal diameter, high blood pressure, increased bifurcation angle, etc.) have also been noticed in studies investigating factors contributing to clinical cases of device migration [9]. However, one cannot apply causation based on the similarity of observed trends.…”

Section: Validitymentioning

confidence: 94%

“…Analytical methods for prediction of stent-graft displacement forces require extreme simplification and significant assumptions [5][6][7]9]. In order to accommodate threedimensional geometries with more realistic configurations, the computational fluid dynamics approach can be used to simulate the blood flow through the reconstructed stent-graft geometries.…”

Section: Computational Fluid Dynamicsmentioning

confidence: 99%

Computational Fluid Dynamics Modeling of Redundant Stent-Graft Configurations in Endovascular Aneurysm Repair

Tse

Shek

Nabovati

et al. 2010

Volume 2: Biomedical and Biotechnology Engineering

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During endovascular aneurysm repair (EVAR), if the stent-graft device is too long for a given patient the redundant (extra) length adopts a convex configuration in the aneurysm.Based on clinical experience, we hypothesize that redundant stent-graft configurations increase the downward force acting on the device, thereby increasing the risk of device dislodgement and failure. This work numerically studies both steady-state and physiologic pulsatile blood flow in redundant stent-graft configurations. Computational fluid dynamics simulations predicted a peak downward displacement force for the zero-, moderate-and severe-redundancy configurations of 7.36, 7.44 and 7.81 N, respectively for steady-state flow; and 7.35, 7.41 and 7.85 N, respectively for physiologic pulsatile flow. These results suggest that redundant stent-graft configurations in EVAR do increase the downward force acting on the device, but the clinical consequence depends significantly on device-specific resistance to dislodgement.ii

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Factors and Forces Influencing Stent-Graft Migration after Endovascular Aortic Aneurysm Repair

Abstract: The mathematical model validated hypertension, aneurysm morphology, and endograft size as clinical factors significantly associated with stent-graft migration. These findings may have important implications for the choice and design of future stent-grafts.

Cited by 92 publications

References 15 publications

Migration of the Nellix endoprosthesis

Migration of the Nellix endoprosthesis

Studying the Flow Dynamics Within Endografts in Abdominal Aortic Aneurysms

Computational Fluid Dynamics Modeling of Redundant Stent-Graft Configurations in Endovascular Aneurysm Repair

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