Postoperative Aortic Neck Dilation: Myth or Fact?

Ribner, A.S.; Tassiopoulos, Apostolos K.

doi:10.1055/s-0038-1649516

Cited by 19 publications

(14 citation statements)

References 23 publications

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“…All devices using stent-fabric combinations for proximal seal seem to cause AND, 17 likely due to the radial force of the sealing stent at the aortic neck. 3 The annual dilatation rate quoted is 0.16 mm/year from smaller studies after open surgical repair (OSR). 18 A median overall AND of 5.3 mm is noted at 48 months after EVAR in some studies; 14 however, some small studies comparing OSR to EVAR found no significant differences in AND.…”

Section: Discussionmentioning

confidence: 99%

“…Radial force at the neck is also implied in contributing to late aortic neck dilatation (AND). 3 It is conceivable that this may vary depending on whether the device skeleton is stainless steel (SS) or nitinol (NT), given that comparative studies suggest that NT-based endografts cause higher rates of AND compared to Co–Cr platforms 4 for instance; the effect of tissue incorporation, particularly in the context of self-expanding, i.e. NT-based endografts and its effect on AND cannot be quantified as tissue incorporation of aortic endoprostheses itself is unpredictable, and not robust enough to prevent migration, thus reinforcing the need for basic fixation adjuncts as a part of aortic endograft design.…”

Section: Introductionmentioning

confidence: 99%

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Endograft platform does not influence aortic neck dilatation after infrarenal endovascular aneurysm repair with primary endostapling

Chaudhuri

Badawy

2020

Vascular

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Objectives Aortic endografts used for endovascular aneurysm repair (EVAR) are based on varying skeletal platforms such as stainless steel or nitinol stents, using radial force applied to seal at the aneurysm neck, and varying proximal fixation methods, applying either suprarenal or infrarenal fixation. This study assesses whether varying skeleton/fixation platforms affect neck-related outcomes after primary endostapling with Heli-FX EndoAnchors at EVAR. Methods Retrospective analysis of a prospective database of infrarenal EVAR undertaken at a single centre. Chimney-EVAR, secondary cases were excluded. Primary outcomes analysed included neck diameter evolution from pre-EVAR to latest imaging follow-up, including a comparison of stent platforms to see if there was any outcome difference between those using stainless steel or nitinol, as also freedom from type I endoleakage and migration. Secondary outcomes assessed included average number of EndoAnchors, and sac size patterns before and after EVAR. Results A total of 101 patients underwent endostapled infrarenal EVAR between September 2013 and March 2020. After exclusion of ineligible patients, 84 patients (76 male, 8 female, age 73.7 ± 7.8 years) were available for analysis. 57/27 endografts used suprarenal/infrarenal fixation, whilst 16/68 devices were based on stainless steel/nitinol platforms, respectively. Mean oversizing was higher for stainless steel/suprarenal fixation endografts ( p = 0.02). A total of 582 EndoAnchors were deployed, averaging 7 ± 2 per patient. Median neck diameter was 25 mm (IQR 22–31) with 22 necks having non-parallel morphology (conical, tapered or bubble). Median follow-up period was 28.5 (IQR 12–43) months. Neck evolution studies suggested aortic neck dilatation of 5 ± 4 mm ( p <0.001, paired T-test), independent of platforms employed ( p = NS, ANOVA). There was no endograft migration; one immediate post-EVAR endoleak settled by eight weeks. There was a mean 5.7 ± 8.2 mm sac size reduction ( p < 0.001, paired T-test). Conclusion Aortic neck dilatation occurs after EVAR with primary endostapling, but the process may be independent of stainless steel/nitinol platforms, possibly due to the attenuating effect of EndoAnchors. Adjunct aneurysm neck fixation by primary endostapling prevents migration regardless of whether suprarenal/infrarenal fixation is the primary fixative method. Device platform choice therefore may be left to the operator discretion if primary endostapling is applied at EVAR. Freedom from complications such as migration and endoleakage in the intermediate term suggests a higher level of ‘tolerance’ to aortic neck dilatation with primary endostapling. We would therefore suggest routine usage of EndoAnchors at EVAR when not otherwise contraindicated.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endograft platform does not influence aortic neck dilatation after infrarenal endovascular aneurysm repair with primary endostapling

Chaudhuri

Badawy

2020

Vascular

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“…The durability of the O-ring EVAR polymer-based devices is due also to the minimum oversize (10–15%) at the proximal seal zone, as opposed to traditional self-expanding stents, which generally require to be oversized by 20% to 30% to ensure apposition of the stent graft to the aortic wall. This rate of oversizing leads to continuous outward radial force being applied to the aneurysm neck [ 90 , 91 , 92 ]. A meta-analysis of neck dilation after EVAR, showed patients with neck dilation were more likely to develop type IA endoleak (persistent filling of the AAA due to incomplete seal or ineffective seal at the proximal end of the stent graft), experience graft migration, or undergo reintervention [ 93 ].…”

Section: Polymer and Endovascular Aneurysm Repairmentioning

confidence: 99%

The Polymer-Based Technology in the Endovascular Treatment of Abdominal Aortic Aneurysms

et al. 2021

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An abdominal aortic aneurysm (AAA) is a dilatation of the abdominal aorta that progressively grows until it ruptures. Treatment is typically recommended when the diameter is more than 5 cm. The EVAR (Endovascular aneurysm repair) is a minimally invasive procedure that involves the placement of an expandable stent graft within the aorta to treat aortic disease without operating directly on the aorta. For years, stent grafts’ essential design was based on metallic stent frames to support the fabric. More recently, a polymer-based technology has been proposed as an alternative method to seal AAA. This review underlines the two platforms that are based on a polymer technology: (1) the polymer-filled endobags, also known as Endovascular Aneurysm Sealing (EVAS) with Nellix stent graft; and (2) the O-ring EVAR polymer-based proximal neck sealing device, also known as an Ovation stent graft. Polymer characteristics for this particular aim, clinical applications, and durability results are hereby summarized and commented critically. The technique of inflating endobags filled with polymer to exclude the aneurysmal sac was not successful due to the lack of an adequate proximal fixation. The platform that used polymer to create a circumferential sealing of the aneurysmal neck has proven safe and effective.

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“…Reversed taper anatomy 64 Conical neck 64 Stent graft deployment outside IFU 11 Pronounced aortic curvature 65 Aortic neck dilatation/remodeling (> 2 mm/y) 23 Emergency EVAR (13)(14)(15)(16) Large neck (> 30 mm)…”

Section: Risk Factorsmentioning

confidence: 99%

“…To date, aortic remodeling and neck dilatation after EVAR represent a challenging reality related to late adverse events and ruptures. 23 Neck dilatation is defined as an increase in aortic neck size of >2 mm or 15%. 24 The pathophysiology of proximal aortic neck dilatation maybe linked to long-standing outward force of oversized self-expanding stents, although this is primarily speculative and the etiology of neck dilatation remains under study.…”

Section: Aortic Remodelingmentioning

confidence: 99%

Evolving Concepts, Management, and Treatment of Type 1 Endoleaks after Endovascular Aneurysm Repair

Gaffey

Damrauer

2020

Semin intervent Radiol

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Over the past 20 years, there has been tremendous progress in endovascular aneurysm repair techniques and devices. The application of new third- and fourth-generation devices (from 2003 onward) has led to changes in the incidence and management of endoleaks. This comprehensive review aims to outline the most recent concepts with respect to pathophysiology/risk factors and management of Type 1 endoleaks.

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Postoperative Aortic Neck Dilation: Myth or Fact?

Cited by 19 publications

References 23 publications

Endograft platform does not influence aortic neck dilatation after infrarenal endovascular aneurysm repair with primary endostapling

Endograft platform does not influence aortic neck dilatation after infrarenal endovascular aneurysm repair with primary endostapling

The Polymer-Based Technology in the Endovascular Treatment of Abdominal Aortic Aneurysms

Evolving Concepts, Management, and Treatment of Type 1 Endoleaks after Endovascular Aneurysm Repair

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