Stent-Graft Migration Following Endovascular Repair of Aneurysms With Large Proximal Necks: Anatomical Risk Factors and Long-term Sequelae
| Autor: | Maurice Lippmann, Jason T. Lee, Rodney A. White, Carlos E. Donayre, Irwin Walot, James T. Lee, George E. Kopchok, Ihab Aziz, Mauricio Heilbron |
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| Rok vydání: | 2002 |
| Předmět: |
Male
medicine.medical_specialty Time Factors medicine.medical_treatment 030204 cardiovascular system & hematology Interactive software 030218 nuclear medicine & medical imaging Computed tomographic Blood Vessel Prosthesis Implantation 03 medical and health sciences Postoperative Complications 0302 clinical medicine Aneurysm Foreign-Body Migration Predictive Value of Tests medicine.artery medicine Device migration Humans Radiology Nuclear Medicine and imaging Renal artery Aged Retrospective Studies Aged 80 and over Aneurysm morphology business.industry Stent Middle Aged medicine.disease Surgery Female Stents Radiology Tomography X-Ray Computed Aortic neck business Cardiology and Cardiovascular Medicine Aortic Aneurysm Abdominal Dilatation Pathologic Follow-Up Studies |
| Zdroj: | Journal of Endovascular Therapy. 9:652-664 |
| ISSN: | 1545-1550 1526-6028 |
| Popis: | Purpose: To evaluate the outcome of aortic endografts deployed in large infrarenal necks and to identify any association of preoperative aneurysm characteristics and postoperative morphological changes with the incidence of neck dilatation and device migration in this patient subset. Methods: The records of 47 patients (41 men; mean age 74, range 55–84) with large aortic neck diameters treated with Talent stent-grafts from 1998 to 2001 were reviewed. Patients with anatomical criteria that precluded aneurysm exclusion with currently available devices were preferentially selected. Mean baseline aneurysm morphology included 27.6-mm (range 18–33.4) suprarenal and 28.1-mm (range 24–34) infrarenal neck diameters; the infrarenal neck length was 26 ± 16 mm with angulation of 37° ± 18°. Computed tomographic (CT) angiograms up to 3 years were analyzed using specialized interactive software; migration was defined as >1-cm change in the distance from the lower renal artery to the top of the device. Pre- and postoperative morphological characteristics of the aneurysm were compared between patients with and without migration. Results: Of the 45 patients successfully treated, 40 had complete CT data for analysis. During a mean 17-month follow-up, 7 (17.5%) of the 40 devices exhibited distal migration. Six patients required secondary procedures; 5 were in the migration cohort. No preoperative anatomical characteristic or degree of neck dilatation over time was predictive of stent-graft migration. Aneurysm sac regression was significant at 1 (–0.09 ± 4.90 mm) and 2 (–1.48 ± 2.56 mm) years in endografts without migration (p1 cm predicted the need for secondary interventions (pConclusions: Endovascular repair is successful in patients with large infrarenal necks and complex neck morphology. Changes in aneurysm remodeling over time were similar to reported observations in patients with more favorable neck criteria. Although no anatomical factor associated with migration could be identified from this analysis, distal displacement >1 cm correlated with the need for a secondary intervention. |
| Databáze: | OpenAIRE |
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