Abstract
ObjectivesTo evaluate the influence of baseline parameters on the occurrence of stent-graft surface movement after endovascular aneurysm repair (EVAR) and to investigate its association with migration and stent-graft-related endoleaks (srEL).MethodsIn this retrospective, cross-sectional study, three-dimensional surface models of the stent-graft, delimited by landmarks using custom-built software, were derived from the pre-discharge and last follow-up computed tomography angiography (CTA). Stent-graft surface movement in the proximal anchoring zone between these examinations was considered significant at a threshold of 9 mm. The Cox proportional hazards model was used to determine baseline variables associated with the occurrence of stent-graft surface movement. The association between migration and srEL with stent-graft surface movement was tested with the chi-square and the Fisher exact test, respectively.ResultsStent-graft surface movement was observed in 54 (28.9%) of 187 patients. Multivariate analysis revealed that age ([HR] 1.05; p = 0.017), proximal neck diameter ([HR] 5.07; p < 0.001), infrarenal aortic neck angulation ([HR] 1.02, p = 0.002), and proximal neck length ([HR] 0.62, p < 0.001) were significantly associated with the occurrence of stent-graft surface movement. Migration and srEL occurred in 17 (31.5%) and 5 (9.3%) patients, with and 11 (8.3%) and 2 (1.5%) without stent-graft surface movement (p < 0.001, p = 0.022).ConclusionsAge, neck diameter, infrarenal neck angulation, and proximal neck length were significantly associated with the occurrence of stent-graft surface movement. Apart from possible use of adjunctive sealing systems, concerned patients may benefit from regular CTA surveillance, enabling timely diagnosis of subtle changes of stent-graft position.Key Points• Stent-graft surface movement, demonstrating subtle, three-dimensional changes in stent-graft position in the proximal anchoring zone, can be derived from CTA examinations.• Age, proximal neck diameter, and infrarenal neck angulation were significantly associated with an increased incidence of stent-graft surface movement. Stent-graft surface movement is significantly more frequent in patients with stent-graft migration and stent-graft-related endoleaks.• Consideration of risk factors for stent-graft surface movement may help to identify patients who might benefit from regular CTA surveillance and timely diagnosis of subtle changes of stent-graft position, enabling re-interventions to prevent migration and srEL.
Highlights
Materials and methodsThe robustness of the overlapping area between the aortic wall and the stent-graft is a determining factor for the long-term durability of endovascular aortic repair (EVAR) [1, 2]
Detection of stent-graft surface movement during computed tomography angiography (CTA). This was a retrospective single-center, cross-sectional study of patients with abdominal aortic aneurysm (AAA) who were followed after elective EVAR
There were four (1.7%) type 1a endoleaks caused by stentgraft migration that resulted in rupture in two patients, 45 and 42 months after treatment
Summary
Materials and methodsThe robustness of the overlapping area between the aortic wall and the stent-graft is a determining factor for the long-term durability of endovascular aortic repair (EVAR) [1, 2]. Stentgraft migration has a reported prevalence ranging from 1.1 to 28% [2,3,4,5] It is responsible for the majority of late complications after EVAR, including late stent-graft-related endoleaks, resulting in aneurysm sac enlargement, and even rupture [6, 7]. Different mechanisms, such as the radial forces of selfexpandable stent-grafts due to oversizing [8, 9] and the pulsatile forces of blood flow [10,11,12], were suggested to be associated with continuous changes in stent-graft position and decreasing apposition of the stent-graft surface, consequentially causing migration over time.
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