Indwelling Stent Research Articles

Clinical significance of pretreatment with double J stent indwelling in the treatment of impacted Ureteral Calculi

Objective To analyze the clinical effects and safety of ureteroscopic lithotripsy (URL) in the treatment of impacted ureteral calculi by pretreatment with double-J stent indwelling. Methods Ninety-six patients with impacted ureteral calculi were enrolled in the study and were divided into one-stage group and two-stage group(pretreatment with double-J stent indwelling), with 48 patients in each group. The clinical effects and safety of the two groups were compared. Results The operative time and the hospital stay in two-stage group were significantly shorter than that in one-stage group, respectively (P<0.05). The success rate of stone clearance rate within 1 month in one-stage group were lower than that in two-stage group (P<0.05). One-stage group has a higher rate of complications compared with two-stage group(P<0.05). Conclusions Rigid combined with flexible ureteroscopic holmium laser lithotripsy is an effcacious and feasible approach for the treatment of impacted ureteral calculi, pretreatment with double-J stent indwelling can increase calculi clearance and improve efficacy and safety. Key words: Ureteral Calculi; Ureteroscopy; Cannula

How to perform EUS-based cholecystolithotomy.

EUS-guided gallbladder drainage (EUS-GBD) is gradually emerging as an option for patients with cholecystitis. A stent-bridged endoscopic intervention in the gallbladder (GB) has been proposed. The formation of a fistulous tract after EUS-GBD facilitates the entry of the endoscope inside the GB to perform endoscopic lithotomy and polypectomy, which is an efficient and safe procedure. However, the technical aspects of this procedure in order to optimize the success rate have only been scarcely discussed. This paper discusses the EUS-GBD prepared for per-oral cholecystolithotomy, the stent indwelling time, the procedure, the devices of per-oral cholecystolithotomy and the follow-up. The recently published literature on this topic is also updated in this review.

Ultrasound Criteria for Assessment of Vertebral Artery Origins

We sought to validate ultrasound as a reliable means of assessing vessel stenosis of vertebral artery origins. We reviewed 1,135 patient charts with ultrasound of the posterior circulation performed in 2008-2015 in a single hospital. Inclusion criteria for native vessels consisted of ultrasound and digital subtraction angiography (DSA) performed within 3 months. Patients with indwelling stents were analyzed separately from native vessels. Using DSA as the gold standard, we determined sensitivity and specificity of ultrasound in detecting occlusion at vertebral artery origin. All patients with nonoccluded native vertebral artery origins were evaluated for degree of stenosis on DSA, and compared to mean flow velocity (MFV), peak systolic velocity (PSV), and end-diastolic velocity (EDV) on ultrasound. Among 218 vertebral artery origins in 139 patients evaluated, ultrasound showed sensitivity of 85.7% (95% confidence interval (CI): 69.7-95.2%) for occlusion and specificity of 99.5% (95%CI: 96.9-99.9%). Among 126 arteries without occlusion, <50% stenosis had average MFV (39±19 cm/s), 50-69% stenosis had average MFV (68±35 cm/s), and severe (70-99%) stenosis had average MFV (120±93 cm/s) (P<.001). MFV cutoff value of 44 cm/s corresponded to 77% sensitivity and 70% specificity to detect vertebral artery origin stenosis >50% (C-statistic: .81). PSV value of 97 cm/s corresponded with 72% sensitivity and 70% specificity to detect >50% stenosis (C-statistic: .77). MFV cutoff value of 60 cm/s corresponded with 70% sensitivity and 82% specificity to predict 70-99% stenosis (C-statistic: .83). PSV cutoff value of 110 cm/s corresponded with 80% sensitivity and 72% specificity to predict 70-99% stenosis (C-statistic: .84). Ultrasound has good sensitivity and excellent specificity for detecting vertebral origin occlusion. Flow velocity can be used to screen for severe stenosis of vertebral artery at origin.

Biliary reintervention with endoscopic inversion technique in the duodenum with the use of short-type double-balloon endoscope in a patient with an indwelling duodenal stent.

Biliary reintervention with endoscopic inversion technique in the duodenum with the use of short-type double-balloon endoscope in a patient with an indwelling duodenal stent.

901 Luminal-Apposing Stents for Benign Intraluminal Strictures: Are We There? U.S. Multicenter Study

INTRODUCTION: Benign gastrointestinal (GI) strictures may occur anywhere in the GI tract but are more common in the upper GI tract or post-surgery. Large amount of these strictures will be resistant for conventional treatments such as balloon or mechanical dilation, incisional therapy, steroid injection, and conventional stents. Recently few small studies reported the use of fully covered lumen-apposing metal stents (LAMS) for benign short strictures. The aim of this study was to evaluate the safety and efficacy of LAMS for refractory GI strictures. METHODS: Patients and Methods Consecutive patients who underwent LAMS placement for various benign strictures seven tertiary care centers were reviewed retrospectively. The primary outcomes were technical success and initial clinical success of LAMS placement. Secondary outcomes were stent migration, rate of re-intervention, and adverse events. RESULTS: Results A total of 51 patients underwent 54 LAMS placement procedures. Median length of the stricture was 8 mm. Previous treatment had failed in 61% of patients. Location of the stricture was found to be at the level of esophagogastric or gastro-Jejunal anastomosis, Pylorus, Ileo-colonic and other in 25%, 21%, 41%, 8% and 5% respectively. A 15 mm × 10 mm LAMS was placed in 32 patients (63%) and a 20 mm × 10 mm LAMS was placed in 19 patients (37%). Median procedure time was 29 min (20-64min). Technical success was achieved in 100% of procedures and initial clinical success was achieved in 98.2% of all procedures. Patient initial clinical success was 49/51 (96%). Mean (range) stent indwell time was 56 (3-126) days. No stent migration occurred during the study period. Adverse events were noted in 10/51 of 25 patients (19%) including pain requiring removal, 1 pain not requiring removal 7; new stricture formation, 1; bleeding, 1). Median follow-up was 162 days after stent placement. CONCLUSION: LAMS are safe and effective in the treatment of short benign GI strictures. The use of larger diameter LAMS such as the new 20mm length my improve outcome and reduce the need of re-intervention. Large prospective studies to the determine the optimal stent size and length of treatment are required.

2195 Expanding Therapeutic Options for Ileocecal Valve and Rectal Strictures With Lumen-Apposing Fully Covered Metal Stents

INTRODUCTION: Radiation-induced and Crohn’s-related colonic strictures are debilitating conditions requiring intensive serial endoscopic dilations or surgery. Use of colonic stents in benign strictures are limited by migration risk, lack of removability, and technical difficulties in placement. This is especially true of ileocecal valve (ICV) strictures given the anatomically challenging location and short stents are preferred. We report the cases of an ICV and distal rectal stricture, refractory to endoscopic dilation, that underwent successful lumen apposing fully covered metal stent (LAMS) placement. CASE DESCRIPTION/METHODS: A 32-year-old African American male with a history of Crohn’s disease complicated by ICV stenosis causing recurrent partial small bowel obstruction, was admitted with worsening nausea, vomiting, and abdominal pain. An abdominal CT showed dilated distal ileum to 4 cm with associated fecalization consistent with partial small bowel obstruction. A colonoscopy with balloon occlusion enterography confirmed a short &lt;1 cm severe ICV stricture with non-inflamed colonic mucosa. He opted for an endoscopic dilation to 10 mm with good clinical response but this only lasted for 2 weeks. A stent placement was then performed using a 15 mm × 10 mm LAMS (Figure 1). His abdominal pain markedly improved with radiologic resolution of the small bowel obstruction. A 55-year-old African American female with a history of pelvic radiation for cervical cancer presented with tenesmus and alternating constipation and diarrhea. Barium enema and flexible sigmoidoscopy showed a focal rectal stricture at 10 cm proximal to the anal verge. She underwent serial endoscopic dilations up to 12-mm over a span of 6 months with no significant clinical response and the stricture kept recurring despite 2-3 week intervals between dilations. Ultimately, a 15 mm × 10 mm LAMS was placed (Figure 2). At 8-weeks, her tenesmus and post-constipation diarrhea were completely resolved. DISCUSSION: Our cases demonstrate the feasibility and efficacy of LAMS placement for refractory high-grade strictures even at anatomically challenging locations. LAMS was preferred here due to its removability and short length that could optimally fit in the ICV and distal rectum with an aim to minimize risk of stent migration due to its dumbbell configuration. However, the stricture site has to be reachable by a therapeutic gastroscope. Optimal duration for stent indwelling and risk of restenosis after stent removal remain unclear and warrant further study.

UP051 - The association of encrustation and ureteral stent indwelling time in urolithiasis and KUB grading system

UP051 - The association of encrustation and ureteral stent indwelling time in urolithiasis and KUB grading system

Symptoms Associated With Long-term Double-J Ureteral Stenting and Influence of Biofilms

ObjectiveTo assess the symptoms associated with long-term Double-J ureteral stenting including the influence of biofilms on ureteral stents. MethodsPatients with long-term (>8 weeks) uni- or bilateral ureteral stents completed the Ureteral Stent Symptoms Questionnaire (USSQ) at the day of stent exchange. Repeated assessment of patients was possible to allow for analysis of intraindividual changes. Assessment of biofilm mass on the stents was performed according to a validated method, its correlation with the USSQ total score was defined as primary outcome. Secondary outcomes included further analyses of stent-associated symptoms and their temporal course. ResultsA total of 87 stent indwelling periods in 35 patients were investigated. Median USSQ total score did not differ significantly between unilateral and bilateral stenting (42 vs 39 points; P = .17). An increasing total stent treatment time up to study inclusion did not correlate with the USSQ total score, but was significantly correlated with less urinary symptoms and a better quality of life. USSQ total score and subscores within individual patients did not significantly increase or decrease over the sequence of stent indwelling periods. Higher total biofilm masses were not associated with higher USSQ total scores or subscores. ConclusionLong-term Double-J stenting provides a valuable treatment option, if stent-associated symptoms are low during the initial indwelling period. Thus, symptoms remain stable over the long-term course and the majority of patients are satisfied with the treatment. Furthermore, biofilm formation on ureteral stents does not seem to be the relevant driver of symptoms.

Treatment Strategy for Progressive Cervical Internal Carotid Artery Stenosis Under Restriction of the Use of Antiplatelet Drugs

Acute ischemic stroke caused by cervical internal carotid artery stenosis (ICS) with altered consciousness and progressive paralysis leads to a poor neurologic prognosis. When such a patient is brought to the hospital in the hyperacute phase, intravenous tissue plasminogen activator is first administered. However, when an indwelling carotid artery stent is required after administration, physicians often hesitate to use antithrombotic drugs. In this report, we propose performing staged angioplasty (SAP) for such cases. Four patients were retrospectively investigated. In all 4 patients, we immediately performed only percutaneous transluminal angioplasty (PTA) without antiplatelet drugs. If both cerebral perfusion on angiography and neurologic findings improved, no additional treatment was provided; otherwise, emergency carotid artery stenting (eCAS) was performed. In PTA-successful cases, eCAS or carotid endarterectomy (CEA) was performed with single or dual antiplatelet drugs at a later date. The success rate of PTA was 50% (2 of 4), and the overall treatment success rate was 100% (4 of 4). Three patients had favorable outcomes (modified Rankin Scale [mRS] score 0-2), but unfortunately, 1 patient had severe disability (mRS score >3) on discharge. The PTA-successful patients had no perioperative complications. On the other hand, 1 of the 2 patients who underwent eCAS experienced embolic complications, including distal embolization. In this investigation, both eCAS and SAP could be performed safety. However, performing SAP first without antiplatelet drugs to avoid hemorrhagic complications and cerebral hyperperfusion syndrome appears to have considerable validity.

Use of esophageal stent for the treatment of postoperative gastrointestinal-airway fistula after esophagectomy.

A gastrointestinal-airway fistula (GAF) after esophagectomy is a very serious postoperative complication that can cause severe respiratory complications due to digestive juice inflow. Generally, GAF is managed by invasive surgical treatment; less-invasive treatment has yet to be established. We performed esophageal stent placement (ESP) in three cases of GAF after esophagectomy. We assessed the usefulness of ESP through our clinical experience. All GAFs were successfully managed by ESP procedures. After the procedure, the stent positioning and expansion were appropriately evaluated by radiological assessments over time. The stent was removed after endoscopic confirmation of fistula closure on days 8, 23, and 71. Only one patient with a long-term indwelling stent developed a manageable secondary gastrobronchial fistula as a procedure-related complication. In conclusion, ESP was shown to be a less-invasive and effective therapeutic modality for the treatment of GAF.

Management of ‘forgotten’ encrusted JJ stents using extracorporeal shockwave lithotripsy: A single-centre experience

ABSTRACTObjective: To evaluate the role of extracorporeal shockwave lithotripsy (ESWL) for the management of ‘forgotten’ encrusted stents.Patients and Method: This is a retrospective study of 133 patients with forgotten JJ stents, treated between January 2015 and January 2018. Encrustation was mainly found in the renal coil of the stent with distal concomitant encrustation in the vesical and/or ureteric segment. After laboratory and radiological assessment, treatment started with ESWL for the renal encrustation before successful extraction. Auxiliary endourological procedures were used for the encrusted vesical or ureteric segments. Failed cases underwent open surgery.Results: The mean (SD; range) JJ stent indwelling time was 25.84 (10; 14–70) months. In all, 96 (72.2%) patients were seen after treatment for stone disease. In total, 94 patients (70.7%) were managed by ESWL monotherapy, whilst in 36 (27%) additional endourological procedures were required before successful extraction including: cystolithotripsy 19 patients (52.8%), ureteroscopic lithotripsy eight (22.2%), and percutaneous nephrolithotomy nine (25%). Open surgery was required in only three patients (2.3%). A mean of 0.28 procedures per patient was required before smooth stent extraction. The encrusted stents were removed after the first, second, third, and fourth ESWL sessions in 44 patients (33.1%), 43 (32.3%), 26 (19.5%), and 17 (12.8%), respectively. Patients with forgotten indwelling JJ stents for >2 years had significantly larger and harder encrustation at both JJ coils.Conclusion: ESWL proved a feasible first-line treatment for forgotten encrusted JJ stents. The indwelling time of forgotten stents in the urinary tract is associated with greater encrustation burden, density and multiple sites of encrustation.Abbreviations: CLT: cystolithotripsy; ESWL: extracorporeal shockwave lithotripsy; HU: Hounsfield unit; KUB: plain abdominal radiograph of the kidneys, ureters and bladder; PCNL: percutaneous nephrolithotomy; URL: ureteroscopic lithotripsy

MP17-18 STRUCTURAL AND MECHANICAL CHANGES OF SOFT AND FIRM POLYURETHANE STENTS: A BENCHTOP STUDY

INTRODUCTION AND OBJECTIVES:Ureteral stents relieve obstruction and maintain renal drainage. However, chronic indwelling stents carry complications including fragmentation, migration, and encrustat...

Safety, efficacy, and removability of a fully covered multi-hole metal stent in a swine model of hilar biliary stricture: a feasibility study.

Background and study aims Use of fully covered self-expandable metal stents (FCSEMS) for biliary drainage of malignant hilar biliary strictures is limited because of risk of cholangitis due to side branch obstruction. The aim of this study was to evaluate the safety and efficacy of unilateral placement of a multi-hole FCSEMS (FCSEMS-MH), which had a 2.5-mm hole in the center of the membrane on each cavity, in a swine model of hilar biliary stricture. Materials and methods Six female mini pigs were included in this prospective study. The hilar biliary stricture model was prepared using an endobiliary radiofrequency ablation. FCSEMS-MHs were endoscopically inserted into the peri-hilar bile duct of all the animals. Outcomes were assessed in terms of adverse events (AEs) including cholangitis, stent patency, stent migration, and endoscopic stent removability for 1 month after stenting. Results In terms of hilar biliary stricture types, two animals were of Bismuth type I and four were of type II. Technical success rate for endoscopic metal stenting was 100 % (6/6), and the functional success rate, which was evaluated 7 days after stent insertion, was also 100 % (5/5). The immediate overall AE rate was 0 %. There was no procedure-related mortality and stent migration did not occur in any animal during the 4-week stent indwelling period. Stents were removed from all six animals at 4 weeks post-stenting. Conclusion Unilateral placement of FCSEMS-MH might be safe and effect for swine hilar biliary stricture models. However, long-term follow-up and comparative studies are needed to verify the usefulness of this stent.

Urinary tract infections in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice.

These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of urinary tract infections (UTI) in solid organ transplantation, focusing on kidney transplant (KT) recipients. KT recipients have unique risk factors for UTI, including indwelling stents and surgical manipulation of the genitourinary tract. KT recipients experience multi-drug antibiotic-resistant infections-UTI prevention and management strategies must consider risks of antimicrobial resistance. Non-antimicrobial prevention strategies for UTI in KT recipients are reviewed. It is important to recognize that some renal transplant recipients with UTI may primarily present with fever, malaise, leukocytosis, or a non-specific sepsis syndrome without symptoms localized to the urinary tract. However, asymptomatic bacteriuria (AB) must be distinguished from UTI because AB is not necessarily a disease state. Accumulating data indicate that there are no benefits of antibiotics for treatment of AB in KT recipients more than 2months after post-transplant. Further research is needed on management of AB in the early (<2months) post-transplant period, prophylaxis for UTI in this era of antibiotic resistance, recurrent UTI, non-antimicrobial prevention of UTI, and uropathogens identified in donor urine and/or preservative fluid cultures.

Risk Factors for the Development of Stent-Associated Cholangitis Following Endoscopic Biliary Stent Placement.

To elucidate the overall risk and risk factors for developing cholangitis following biliary stent placement by endoscopic retrograde cholangiopancreatography (ERCP) and to determine the clinical outcomes of these individuals. We performed a retrospective review of 796 patients who had undergone 1127 ERCPs with biliary stent placement between 2007 and 2015 at a single tertiary care center. There were 91 episodes of stent-associated cholangitis (SAC) during the study period. Data obtained through the medical records included ERCP indication, patient factors (biliary anatomy, demographics, and comorbidities), stent characteristics (material, length, and design), change in serum bilirubin, stent indwelling time, rates and etiologies of bacteremia, and the mortality rate. Those with SAC were more likely to have an anatomic biliary stricture (13.1% vs. 2.3%, p < .0001), with hilar and multiple strictures having the highest risk (19.1% vs. 11.6%, p = .04). The ERCP indication of malignant biliary obstruction was associated with higher rates of SAC (15.6% vs. 3.4%, p = < .0001). Rates of SAC were higher in those who failed to normalize total bilirubin (16.9% vs. 7.8%, p = .0005), and these episodes occurred earlier compared to those who normalized total bilirubin (median 30.5days vs. 140.5days, p < .0001). Patients at increased risk of SAC include those with an anatomic stricture, malignant biliary obstruction, and those who fail to normalize total bilirubin after biliary stent placement. Future protocols should be designed to reduce the risk of cholangitis in these populations.

Viabahn stent graft in the management of a grade 3 coronary perforation

BackgroundCoronary artery perforation during coronary intervention has high morbidity and mortality. This case describes the collaboration between interventional cardiologists and Interventional radiologists to successfully deploy a peripheral arterial stent graft in a coronary artery that demonstrated persistent extravasation after coronary specific stent graft placement.Case presentationAn 84 year old female patient presented with acute coronary syndrome and coronary angiography identified a right coronary artery lesion. This was dilated and stented but resulted in a grade 3 coronary perforation. Conservative treatment with balloon tamponade failed, as did placement of a covered coronary-specific stent graft. A Viabahn peripheral arterial stent graft was placed within the indwelling stents and successfully sealed the endoleak. At 6 months the patient is clinically well and follow-up imaging has demonstrated stent patency.ConclusionsIn the emergency setting when coronary artery perforation fails to respond to standard initial and bail out techniques, peripheral arterial techniques and devices can be extremely useful. A good relationship between interventional cardiology and radiology is paramount.

Uretero-arterial Fistula by a Double-J Ureteric Stent in a Stented Internal Iliac Artery Aneurysm

We represent a-65-year-old male patient presented with indwelling left JJ stent for obstructed solitary kidney drainage. The obstruction was due to internal iliac artery aneurysm, had been managed by trans-femoral self-expandable coated endovascular stenting. This patient readmitted with recurrent attacks of hematuria with displaced JJ stent and rising serum creatinine twice. In the first admission, the patient was managed by JJ stent readjustment and Percutaneous Nephrostomy tube (PCN) and was discharged safely. Again, he presented with UAF associated with aggressive hematuria mostly due to vascular endoleak rupture. The patient developed severe sepsis and multiple organ dysfunction syndrome.

Safety and clinical outcomes of endoscopic ultrasound-guided gallbladder drainage with lumen-apposing metal stents in patients with dwell time over one year.

Background:Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has proved effective in patients with cholecystitis at high surgical risk. The long-term risks of gallstone-related disease and stent-related adverse events are unknown.Methods:We performed a retrospective evaluation of a case series including subjects who underwent EUS-GBD using lumen-apposing metal stents (LAMS). Patients were identified from a prospective LAMS registry at a single tertiary center. Patients with a stent indwell time <1 year were excluded. Data regarding stent deployment and adverse events were retrieved from the prospective LAMS registry, while emergency room visits, admissions and causes of death were retrieved from electronic medical records.Results:We included 22 patients with a median age of 88.3 years (interquartile range [IQR]: 82.6-92.7), 14 (63.6%) were male. Median follow up was 24.4 months (IQR: 18.2-42.4) and median time to the last available imaging procedure was 607 days (IQR: 463-938). No LAMS-related adverse events were identified beyond the first year of follow up. During follow up, 12 patients (54.5%) visited the emergency room 34 times (1 visit/patient, IQR: 0-3) and a total of 36 hospital admissions were required, with a median of 1 admission/patient (IQR: 0-3). Fourteen (63.6%) patients died during follow up. Only 1 patient (4.5%) required new hospital admissions for gallstone-related disease.Conclusions:There were no adverse events beyond the first year after stent deployment, with only 4.5% of subjects requiring gallstone-related admissions. Permanent EUS-GBD with LAMS may be a definitive treatment for acute cholecystitis in patients ineligible for cholecystectomy.

Multiple plastic versus fully covered metal stents for managing post-liver transplantation anastomotic biliary strictures: a meta-analysis of randomized controlled trials.

BackgroundAnastomotic biliary strictures (ABS) following liver transplantation (LT) are one of the most common complications, occurring in 4.5-32% of patients. Multiple plastic stenting (MPS) requires multiple sessions, with the associated risk, cost and patient discomfort. Fully covered self-expandable metal stents (FC-SEMS) have increasingly been used in this setting. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs), comparing the role of FC-SEMS and MPS in the treatment of ABS post-LT.MethodsWe conducted a bibliographic search using PubMed and EMBASE, aimed at identifying available RCTs that compared MPS to FC-SEMS in patients with ABS post LT from January 2000 to October 2017. Primary outcomes were ABS resolution and recurrence, while secondary outcomes were adverse events and number of procedures performed. Pooled estimates were calculated using random-effects models.ResultsFour RCTs (205 patients) were included. ABS resolution and recurrence did not differ significantly between the groups (odds ratio [OR] 1.05, 95% confidence interval [CI] 0.43-2.56, P=0.92; and OR 2.37, 95%CI 0.54-10.38, P=0.25). The same was true for adverse events (OR 0.91, 95%CI 0.84-3.48, P=0.86) and migration rate (OR 1.31, 95%CI 0.46-3.71, P=0.61). The mean number of endoscopic retrograde cholangiopancreatography procedures was lower for FC-SEMS (mean difference [MD] -2.08).ConclusionsFC-SEMS and MPS had equal ABS resolution and recurrence, although there was a trend towards a higher recurrence rate in FC-SEMS that disappeared when trials with a shorter stent indwelling time were excluding. No difference was found in overall adverse events or migration rate.

Postoperative thoracic and low back pain following endovascular aortic repair associated with stenting location.

We have noted that patients frequently complain of thoracic or low back pain after undergoing an endovascular aortic repair, which we speculated was caused by the indwelling stent. We investigated the patients who underwent an elective thoracic or abdominal endovascular aortic repair (TEVAR or EVAR) and noted the location of stent, and postoperative pain. The incidence of either thoracic or low back pain at individual vertebra levels was determined, after which we fitted the sigmoidal function to the discrete data to obtain a cut-off line. The study patients were then divided into 2 groups using the cut-off line to compare the incidence of pain. We analyzed 96 patients (68 TEVAR, 28 EVAR). The incidence of thoracic pain was significantly higher in TEVAR as compared to EVAR (26.5% vs. 3.6%, P = 0.01), while that of low back pain was significantly higher in EVAR (35.7% vs. 16.2%, P = 0.04). With the cut-off line for thoracic pain set at the 12th thoracic vertebra, the incidence of thoracic pain was significantly higher in patients with the upper end of the stent above the cut-off as compared to at a lower point (26.5% vs. 3.6%, P = 0.01). As for low back pain, the cut-off line was set at the 9th thoracic vertebra, and the incidence of that pain was significantly higher in patients with the lower end of the stent below that line (30.9% vs. 0.0%, P < 0.01). Thoracic and low back pain after an endovascular aortic repair procedure were associated with stenting site.