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

Waasdorp, E.J.; de Vries, J.-P.P.M.; Sterkenburg, A.; Vos, J.-A.; Kelder, H.J.C.; Moll, F.L.; Zarins, C.K.

doi:10.1016/j.ejvs.2009.03.001

« Previous Next »European Journal of Vascular & Endovascular Surgery
Volume 37, Issue 6 , Pages 681-687, June 2009

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

E.J. Waasdorp
- Department of Vascular Surgery, St. Antonius Hospital Nieuwegein, The Netherlands
J.-P.P.M. de Vries
- Department of Vascular Surgery, St. Antonius Hospital Nieuwegein, The Netherlands
A. Sterkenburg
- Department of Vascular Surgery, St. Antonius Hospital Nieuwegein, The Netherlands
J.-A. Vos
- Department of Interventional Radiology, St. Antonius Hospital Nieuwegein, The Netherlands
H.J.C. Kelder
- Department of Vascular Surgery, St. Antonius Hospital Nieuwegein, The Netherlands
F.L. Moll
- Department of Vascular Surgery, University Medical Center, Utrecht, The Netherlands
C.K. Zarins
- Department of Vascular Surgery, Stanford University Medical Center, Stanford, California, USA
- Corresponding author. Christopher K. Zarins, Chidester Professor of Surgery, Stanford University School of Medicine, Clark Center, 318 Campus Drive West, E350, Stanford, CA 94305-5431, USA.

Received 21 November 2008; accepted 1 March 2009. published online 01 April 2009.

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 ≥10mm). 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±12mm vs. 41±13mm, P<0.001) and distal endograft fixation lengths (31±18mm vs. 47±15mm, P<0.001). By multivariate regression analysis, proximal and distal endograft fixations were significant predictors for endograft migration at follow-up (P<0.001).