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Related Experiment Videos

Late problems at the proximal aortic neck: migration and dilation.

Britt H Tonnessen1, W Charles Sternbergh, Samuel R Money

  • 1Section of Vascular Surgery, Ochsner Clinic Foundation, New Orleans, LA 70121, USA.

Seminars in Vascular Surgery
|December 23, 2004
PubMed
Summary

Endograft migration after endovascular aneurysm repair (EVAR) can occur due to fixation issues or aortic neck dilation. Devices with active fixation may reduce migration risk, and early treatment is crucial to prevent aneurysm rupture.

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Area of Science:

  • Vascular Surgery
  • Medical Device Engineering

Background:

  • Endovascular aneurysm repair (EVAR) is a common treatment for abdominal aortic aneurysms.
  • Graft migration is a recognized late complication of EVAR, potentially leading to serious adverse events.
  • Understanding the causes and management of EVAR graft migration is critical for patient outcomes.

Purpose of the Study:

  • To review the etiology and contributing factors of endograft migration after EVAR.
  • To discuss the role of endograft fixation mechanisms in preventing migration.
  • To outline the indications and importance of treating EVAR graft migration.

Main Methods:

  • Literature review of endovascular aneurysm repair complications.
  • Analysis of factors influencing endograft migration, including fixation and aortic neck changes.

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  • Discussion of clinical significance and treatment thresholds for migration.

    • Main Results:

    • Graft migration is characterized by endograft slippage, often linked to fixation deficits or aortic neck dilation.
    • Active fixation mechanisms (hooks, barbs) may enhance resistance to migration.
    • Excessive endograft oversizing is associated with increased risk of dilation and migration.

    Conclusions:

    • Aortic neck dilation and endograft fixation are key factors in EVAR migration.
    • Active fixation devices may offer improved migration resistance.
    • Timely intervention for migration (overlap <10mm or associated complications) is essential to prevent aneurysm re-expansion and rupture.