Thoracic Stent-Graft Migration: The Role of the Geometric Modifications of the Stent-Graft at 3 years.
Aged
Aortic Aneurysm, Thoracic
/ diagnostic imaging
Aortography
/ methods
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation
/ adverse effects
Computed Tomography Angiography
Endoleak
/ etiology
Endovascular Procedures
/ adverse effects
Female
Foreign-Body Migration
/ diagnostic imaging
Humans
Male
Middle Aged
Prosthesis Design
Prosthesis Failure
Retrospective Studies
Risk Factors
Stents
Time Factors
Treatment Outcome
Journal
Annals of vascular surgery
ISSN: 1615-5947
Titre abrégé: Ann Vasc Surg
Pays: Netherlands
ID NLM: 8703941
Informations de publication
Date de publication:
Jul 2019
Jul 2019
Historique:
received:
15
07
2018
revised:
08
10
2018
accepted:
10
10
2018
pubmed:
27
1
2019
medline:
30
7
2019
entrez:
27
1
2019
Statut:
ppublish
Résumé
To date, clinical and experimental studies on stent graft (SG) migration have focused on aortic morphology and blood flow. However, thoracic endovascular aortic repair (TEVAR) is not an instant fixation of the SG in the aortic lumen but rather a continuous process of deformation and three-dimensional change in the configuration and the geometry of the SG. The aim of this study was to analyze the geometric evolution of the aortic SG in the proximal attachment zone at midterm follow-up and its impact on the SG migration. Sixty-two patients underwent TEVAR for thoracic aortic aneurysm from 2007 till 2013. Thirty patients were treated and had a complete clinical and morphological follow-up at 1 month and 3 years. We calculated the SG radius of curvature (RC) change at the proximal attachment zone "P" on the postoperative computed tomography scan at 1 month and 3 years. There were 19 atheromatous aneurysms, 8 postdissection aneurysms, and 3 posttraumatic aneurysms. Two patients were treated at zone 1, seven at zone 2, and twenty-one at zone 3. The median decrease of the RC at "P" was 11 mm (interquartile range, 6.5 mm; range, 1-29 mm. A greater decrease in RC was identified in patients with hostile proximal neck having a large diameter (P = 0.006), short neck length (P = 0.04), and neck thrombus grade II and III (P = 0.02). In the migration group, the RC of "P" decreased significantly at 3 years (27.5 mm vs 18.25 mm; P = 0.03). Three patients had type I endoleak and showed a decrease of the RC at "P" (42 vs 13 mm; 28 vs 15 mm; 24 vs 9 mm). The SG seems to have geometric changes in the proximal attachment zone over time. The increase of SG curvature might be a predictor for SG migration and may prompt prophylactic reintervention.
Sections du résumé
BACKGROUND
BACKGROUND
To date, clinical and experimental studies on stent graft (SG) migration have focused on aortic morphology and blood flow. However, thoracic endovascular aortic repair (TEVAR) is not an instant fixation of the SG in the aortic lumen but rather a continuous process of deformation and three-dimensional change in the configuration and the geometry of the SG. The aim of this study was to analyze the geometric evolution of the aortic SG in the proximal attachment zone at midterm follow-up and its impact on the SG migration.
METHODS
METHODS
Sixty-two patients underwent TEVAR for thoracic aortic aneurysm from 2007 till 2013. Thirty patients were treated and had a complete clinical and morphological follow-up at 1 month and 3 years. We calculated the SG radius of curvature (RC) change at the proximal attachment zone "P" on the postoperative computed tomography scan at 1 month and 3 years.
RESULTS
RESULTS
There were 19 atheromatous aneurysms, 8 postdissection aneurysms, and 3 posttraumatic aneurysms. Two patients were treated at zone 1, seven at zone 2, and twenty-one at zone 3. The median decrease of the RC at "P" was 11 mm (interquartile range, 6.5 mm; range, 1-29 mm. A greater decrease in RC was identified in patients with hostile proximal neck having a large diameter (P = 0.006), short neck length (P = 0.04), and neck thrombus grade II and III (P = 0.02). In the migration group, the RC of "P" decreased significantly at 3 years (27.5 mm vs 18.25 mm; P = 0.03). Three patients had type I endoleak and showed a decrease of the RC at "P" (42 vs 13 mm; 28 vs 15 mm; 24 vs 9 mm).
CONCLUSIONS
CONCLUSIONS
The SG seems to have geometric changes in the proximal attachment zone over time. The increase of SG curvature might be a predictor for SG migration and may prompt prophylactic reintervention.
Identifiants
pubmed: 30684612
pii: S0890-5096(19)30046-9
doi: 10.1016/j.avsg.2018.10.024
pii:
doi:
Types de publication
Journal Article
Langues
eng
Pagination
16-23Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.