The Association between Iliac Fixation and Proximal Stent-graft Migration during EVAR Follow-up: Mid-term Results of 154 Talent Devices

Abstract

Objective: This study investigated the importance of iliac fixation to secure endograft fixation. Materials and methods: Computed tomography (CT) scans of patients who underwent endovascular aneurysm repair with an endoprosthesis of great columnar strength (Talent™ stent graft) were analysed retrospectively. Patients were enrolled consecutively between June 2000 and January 2007 and prospectively followed up with serial CT imaging. The superior mesenteric artery was used as a reference point to determine endograft migration (centerline endograft displacement of ≥10 mm). Proximal and distal fixation lengths were defined as the length of the endograft that was in full apposition to the aortic neck or common iliac arteries, respectively. Results: Proximal endograft migration occurred in 32 of 154 patients (21%) at a follow-up duration of 32 ± 14 months; 13 migrations required treatment (8%). Migration was more frequent in patients treated with aorto-uniiliac devices than bifurcation devices (p < 0.008). The migrator and non-migrator groups had similar demographic and abdominal aortic aneurysm (AAA) characteristics. The migrator group had significantly shorter proximal (30 ± 12 mm vs. 41 ± 13 mm, P < 0.001) and distal endograft fixation lengths (31 ± 18 mm vs. 47 ± 15 mm, P < 0.001). By multivariate regression analysis, proximal and distal endograft fixations were significant predictors for endograft migration at follow-up (P < 0.001). Conclusion: Iliac endograft fixation, along with proximal fixation, is a significant predictor for endograft migration.