Stent Graft Dislocation after EVAR Treated with an Endostapling Fixation System.

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Medical Device Technology

Background:

• Endovascular Aneurysm Repair (EVAR) is a common treatment for Abdominal Aortic Aneurysm (AAA).
• Stent-graft migration and Type I endoleak are significant complications, particularly in patients with challenging proximal neck anatomy.
• Managing these complications is crucial for long-term EVAR success.

Observation:

• An 88-year-old female with a large infrarenal AAA and severely angulated neck underwent EVAR with a Gore Excluder stent-graft.
• Postoperative imaging revealed stent-graft dislocation and a proximal Type I endoleak.
• The patient had challenging anatomy, including a 56-mm AAA diameter and angulated iliac arteries.

Findings:

• A proximal cuff and six endostaples were used to secure the stent-graft and seal the proximal neck.
• This intervention successfully excluded the Type I endoleak.
• Two-year follow-up Computed Tomography Angiography (CTA) confirmed the absence of endoleak and stable stent-graft position.

Implications:

• Endostapling fixation systems offer a viable solution for stent-graft dislocation in anatomically challenging EVAR cases.
• This technique can effectively manage proximal neck sealing issues and prevent endoleaks.
• The findings suggest endostapling as a valuable adjunct for improving EVAR outcomes in complex patients.