RR4. Sideways Movement of the Endograft Within the Aneurysm Sac Is Associated With Late Adverse Events

Abstract

Previous studies have shown the importance of proximal and distal endograft fixation. There is little information on the middle, unsupported section of the endograft. We have quantified sideways movement of the endograft within the AAA sac and correlated it to late adverse events. Patients who underwent EVAR between January 1997 and December 2007 were analyzed. Patients with a digital available preoperative CT-angiography (CTA), postoperative CTA and at least one follow-up CTA thereafter were included. Changes in endograft position within the AAA sac were measured. Patients with sideways movement ≥5mm were placed in the movement group (MG) and were compared with patients with no movement (<5mm, NM group). To analyze the association of sideways endograft movement and EVAR related complication the following outcome measures were noted: AAA rupture, AAA-related death, conversion, secondary procedures, AAA growth (≥5mm), proximal migration (≥10mm), and new onset type 1/3 endoleaks. 144 patients (mean age 76 year) were included. Follow-up was 43 ± 27 months. Fifty patients (35%) had sideways endograft movement. AAA diameter (MG 60 ± 9 vs NM 57 ± 9mm, p < 0.05), and proximal and iliac endograft fixation lengths were significantly different between the groups (MG 18 ± 8 vs NM 25 ± 11mm, p < 0.05 and MG 35 ± 15 vs NM 42 ± 16mm, p < 0.05). There was no significant difference between the groups in terms of AAA rupture and AAA-related death (one fatal AAA rupture, NM group). Patients in the MG group had a significantly higher conversion rate (14 vs 0%, p < 0.001) and had more secondary procedures (44 vs 6%, p < 0.001). Patients in the MG had significantly more AAA growth (42 vs 10%, p < 0.001), more proximal migration (66 vs 5%, p < 0.001) and more often type 1/3 endoleaks (36 vs 3%, p < 0.001). Sideways movement of the device within the AAA sac is associated with late adverse events. Conversely, lack of movement is correlated with long-term success.