PS6. The Proximal Aneurysm Neck Distension in Patients With Stentgraft Migration Is Significantly Larger Than in Patients Without Migration

Abstract

The proximal AAA neck expands significantly during the cardiac cycle, both before and after EVAR. Clinical consequences of this pulsatility are expected but never reported. The goal of this study is to investigate whether there is a relation between stentgraft migration and AAA neck distension. EVAR patients with a preoperative dynamic CTA, an immediate postoperative, and a CTA 3 years after EVAR were included. The preoperative dynamic CTAs consisted of 8 images per heartbeat. Aortic area and diameter changes per heartbeat were measured at 2 levels: (A) 3cm above and (B)1cm below the distal renal artery. Postoperatively, the distance between this renal artery and the most proximal stentgraft ring was measured. The pulsatility of patients with ≥5mm stentgraft migration after 3 years was compared to the pulsatility of patients without migration. All given values are mean. 26 patients were included (19 Talent, 6 Excluder, 1 Lifepath). 11 of them had stentgraft migration of ≥5mm (group 1). The pulsatility of the AAA neck in these patients was compared to the pulsatility in 15 patients with no graft migration (group 2). There were no significant differences in aortic neck characteristics (angulation, length, diameter) or degree of oversizing between the 2 groups. The diameter increase per heartbeat at level A in group 1 was 2.0 ± 0.3, and 1.7 ± 0.3mm in group 2. The aortic area increase was 49 ± 15 (group 1) and 33 ± 12 mm2 (group 2). The diameter increase per heartbeat at level B in group 1 was 1.8 ± 0.3, and 1.6 ± 0.4mm in group 2. The area increase at level B was 37 ± 10 (group 1) and 25 ± 15 mm2 (group 2). The heartbeat dependent diameter and area changes at both levels were significantly higher in patients of group 1 compared to those of patients in group 2 (all p < 0.05). The aortic distension is significantly higher in patients with stentgraft migration than in patients without stentgraft migration. Patients with higher aneurysm neck pulsatility are more prone to stentgraft migration.