Prosthetic stent graft infection after endovascular abdominal aortic aneurysm repair

OBJECTIVE: The purpose of this report is to discuss the incidence, diagnosis, and management of stent graft infections after endovascular aneurysm repair (EVAR). METHODS: Data were collected from the hospital database and medical case notes for all patients with infected endografts after elective or emergency EVAR for abdominal aortic aneurysm (AAA) during the last 8 years in two university teaching hospitals in Northern Ireland. The data included the patient's age, gender, presentation of sepsis, treatment offered, and the ultimate outcome. The diagnosis of graft-related sepsis was established by a combination of investigations including inflammatory markers, labelled white cell scan, computed tomography (CT) scan, microbiology cultures, and postmortem examination. RESULTS: Graft-related septic complications occurred in six of 509 patients, including 433 elective repairs and 76 emergency endografts for ruptured AAA. Two patients presented with left psoas abscess and were treated successfully with extra-anatomic bypass and removal of the infected stent graft. Two more patients presented with infected graft without other evidence of intra-abdominal sepsis: one underwent successful removal of the infected prosthesis with extra-anatomical bypass, and the other was treated conservatively and died of progressively worsening sepsis. The fifth patient presented with unexplained fever and died suddenly, with a postmortem diagnosis of aortoenteric fistula and ruptured aneurysm. The last patient presented with an aortoenteric fistula, was treated conservatively in view of concurrent myelodysplasia, and died of possible aneurysm rupture. CONCLUSION: This report emphasizes the need for continued awareness of potential graft-related septic complications in patients undergoing EVAR of AAA. Attention to detail with regard to sterility and antibiotic prophylaxis during stent grafting and during any secondary interventions is vital in reducing the risk of infection. In addition, early recognition and prompt treatment are essential for a successful outcome.     

Gender differences in endovascular abdominal aortic aneurysm repair with the AneuRx stent graft

OBJECTIVE: The objective of this study was to evaluate gender differences in the selection, procedure, and outcome of endovascular abdominal aortic aneurysm repair (EVAR). PATIENTS: Between October 1996 and January 2001, 378 patients were evaluated for EVAR and 189 patients underwent EVAR with the Medtronic AneuRx stent graft at a single center. RESULTS: Women constituted 17% of patients considered for EVAR. Their eligibility rate (49%) did not differ significantly from that of men (57%), and they constituted 14% of patients who underwent EVAR (26/189). Women who underwent EVAR were older (77.9 +/- 6.3 years versus 73.1 +/- 8.1 years; P <.005) with a higher rate of chronic obstructive lung disease (50% versus 28%; P <.05). Maximal aneurysm diameter (57.2 +/- 10.9 mm versus 57.8 +/- 9.4 mm; not significant) did not differ between men and women. Mean diameters of the proximal neck (20.4 +/- 2.3 mm versus 22.3 +/- 2.0 mm; P <.01), common iliac arteries (11.4 +/- 1.2 mm versus 13.5 +/- 3.6 mm; P <.001), and external iliac arteries (7.9 +/- 0.7 mm versus 9.4 +/- 1.4 mm; P <.001) were all smaller in women, and abdominal aortic aneurysm/neck diameter ratio was larger (2.82 +/- 0.59 versus 2.60 +/- 0.49; P <.05). The length of the proximal aortic neck was shorter in women (20.7 +/- 8.2 mm versus 24.5 +/- 11.8 mm; P <.05). Women had significantly more intraoperative complications (31% versus 13%; P <.05), primarily related to arterial access, and needed more frequent arterial reconstruction (42% versus 21%; P <.05), without a difference in postoperative mortality rate (0/26 versus 2/163; not significant) and complication rate (23% versus 20%: not significant). During a follow-up period of 13.8 +/- 11.7 months, no gender-related difference was found in survival rate, endoleak rate, or reintervention rate or in the rate of change in aneurysm diameter or volume. CONCLUSION: Eligibility rates of women for EVAR are similar to those of men. Women are at an increased risk for access-related complications during EVAR, but outcome is equivalent to that of men.     

Aortoduodenal fistula 5 years after endovascular abdominal aortic aneurysm repair with the Ancure stent graft

We report a case of aortoduodenal fistula 5 years after uncomplicated endovascular abdominal aortic aneurysm repair. The diagnosis was confirmed by abdominal computed tomography scan and esophagogastroduodenoscopy. The patient was successfully treated with primary duodenal repair, removal of the infected graft, in situ placement of a bifurcated graft, and omental interposition. Review of the literature identifies this as one of very few documented aortoduodenal fistulas after endovascular aneurysm repair. Fistulization occurred despite accurate stent graft placement without migration, endoleak, or aortic sac size enlargement on annual postoperative imaging studies.     

Suprarenal stent perforation after endovascular abdominal aortic aneurysm repair

A 66-year-old man with an abdominal aortic aneurysm previously repaired with an endovascular stent graft presented to our facility with worsening midabdominal and back pain. Previous postoperative surveillance computed tomography scans were unremarkable, showing excellent stent-wall apposition and a shrinking aneurysm sac; however, imaging done on his arrival identified a contained rupture at the level of the celiac artery containing a perforating suprarenal stent. We repaired this rupture with a surgeon-modified fenestrated stent graft. To our knowledge, this is the first reported case of penetration of the native aorta by a suprarenal stent in the absence of infection or trauma.     

Long-term outcome and reintervention after endovascular abdominal aortic aneurysm repair using the Zenith stent graft

OBJECTIVE: To assess the long-term performance of the bifurcated Zenith stent graft. METHODS: A total of 325 patients (300 men and 25 women) underwent elective endovascular abdominal aortic aneurysm repair with bifurcated Zenith stent grafts between October 1998 and December 2005. Follow-up included routine contrast-enhanced computed tomography and multiview abdominal radiographs at 1, 6, and 12 months and yearly thereafter. Data on late-occurring (>30 days after stent-graft implantation) complications and interventions were collected prospectively. RESULTS: Of the original 325 patients, 92 have since died, resulting in a mean follow-up of 2.3 years (range, 1 month to 7.0 years). Nine (2.8%) of 325 patients required reintervention to treat or prevent endoleak (type I or III) or graft occlusion at an average of 1.4 years after stent-graft placement (range, 40 days to 4.0 years). Three (0.9%) of these patients died from causes related to malfunction of the stent graft: one each from aneurysm rupture, stent-graft infection, and infection of a femoral-femoral bypass graft placed after limb occlusion. Nineteen additional patients (5.8%) required treatment for type II endoleak, for a total reintervention rate of 8.6%. CONCLUSIONS: Late failures of Zenith stent-graft attachment, structure, or function are rare. In the absence of known endoleak, routine follow-up imaging plays a limited role in the identification and prevention of impending failure.     

Successful renal transplantation after endovascular bifurcated stent graft repair of an abdominal aortic aneurysm

Renal transplantation after repair of aortoiliac aneurysms with traditional prosthetic vascular grafts has been shown to be effective. Vascular surgery continues to rapidly evolve, most notably with the advancement of endovascular repair of abdominal aortic aneurysms. Controlled trials continue to support the trend toward the use of endovascular bifurcated aortic stent grafts. For this we describe the first renal transplant in a patient with an endovascular bifurcated aortoiliac stent graft. No intraoperative difficulties were encountered. At 1-year follow-up, the transplanted kidney is functioning well with a normal serum creatinine level of 1.3 mg/dl, and the patient has no worsening of peripheral vascular disease. We recommend that the presence of an endovascular aortic graft not be a contraindication to renal transplantation.     

Late abdominal aortic aneurysm enlargement after endovascular repair with the Excluder device

OBJECTIVES: Behavior of the abdominal aortic aneurysm (AAA) sac after endovascular abdominal aortic aneurysm repair (EVAR) is graft-dependent. The Excluder endograft has been associated with less sac regression than some other stent grafts. Long-term follow-up has not been reported. METHODS: Between May 1999 and July 2002, 50 patients underwent EVAR with the Excluder bifurcated endoprosthesis. These patients were followed up prospectively with computed tomography (CT) at 1, 6, and 12 months and yearly thereafter. One immediate conversion to open surgery and three deaths occurred within 6 months. One additional patient was lost to follow-up. The remaining 45 patients, 35 men and 10 women, were followed up for at least 1 year, and form the basis for this report. Their mean age was 73 +/- 5.5 years. The minor axis diameter at the largest area of the AAA on CT examination was compared with the baseline measurement at 1 month and to the smallest size previously recorded during follow-up. Change in sac size of 5 mm or greater was considered significant. Mean follow-up was 2.7 +/- 1.2 years (range, 1-4 years). Nominal variables were compared with the chi(2) test, and continuous variables with the Student t test. RESULTS: A significant decrease in average AAA sac diameter was observed at 6-month, 1-year, and 2-year follow-up. These differences were lost by the 3-year evaluation, because of delayed sac growth (n = 9) and re-expansion of once shrunken aneurysms (n = 3). The probability of freedom from sac growth or re-expansion at 4 years was only 43%. At last follow-up, sac expansion occurred in the absence of active endoleak in nine patients. Type II endoleak was associated with sac expansion in three patients (P =.003), resulting in one conversion to open surgery after the 4-year follow-up. No graft migrations, AAA ruptures, or aneurysm-related deaths were noted. CONCLUSIONS: Late aneurysm sac growth or re-expansion after EVAR with the Excluder device is common, even in the absence of endoleak. Although the incidence of important clinical sequelae is low at this point, the incidence of aneurysm expansion should be taken into consideration during the risk-benefit assessment before EVAR repair with the Excluder device.     

腹主动脉瘤腔内修复术后近端瘤颈直径改变

目的 回顾性观察腹主动脉瘤腔内修复术后近端瘤颈直径变化,并分析其影响因素.方法 对1997年1月至2007年1月接受腔内修复术治疗并符合入选标准的45例患者进行回顾性分析.其中男性44例,女性1例,平均年龄(69±17)岁,均为无症状腹主动脉瘤;合并高血压病37例,冠状动脉粥样硬化性心脏病40例.所有患者具有完整术前CT资料,并接受6个月以上的定期增强CT随访(术后1、3、6、12个月及以后每年).通过CT评价术后近端瘤颈直径的变化情况,以增加≥2 mm为有变化,<2 mm时为无变化.结果 全组患者随访9～100个月,平均随访(34±25)个月.术前瘤颈直径(21.5±2.3)mm,术后1个月时瘤颈直径(22.4±2.4)mm,最近1次随访瘤颈直径(24.0±2.8)mm.瘤颈直径增加率71.1%.支架比瘤颈直径增大百分比19%±6%.瘤颈直径大于支架标定型号者占6.7%.随访16个月时无瘤颈扩张率为97.4%,24个月时无瘤颈扩张率为68.6%,36个月时无瘤颈扩张为39.3%,96个月时无瘤颈扩张率为3.3%.支架移位率为22.2%,移位距离0～9.5 mm,平均(7.0±1.3)mm,无移位10 mm以上者,没有因为移位需要进行二次治疗者.结论 支架比瘤颈直径增大百分比越大,术后1个月瘤颈扩张越多.支架型血管的移位与中远期瘤颈扩张有相互促进作用.

Abstract：

Objectives To review the dilatation of the proximal neck in abdominal aortic aneurysm (AAA) after endovascular repair (EVR), and to analyze the factors contributed to these changes. Methods From January 1997 to January 2007, a total of 45 patients treated by EVR met the inclusion criteria. There were 44 male and 1 female patients, with an average age of (69 ± 17) years. The patients were all asymptomatic abdominal aortic aneurysm, combined hypertension in 37 cases, coronary heart disease in 40 cases. All the patients had the complete preoperative enhanced CT information, and accepted more than 6 months of regular enhanced CT follow-up (1,3,6, 12 months after surgery and annually thereafter). The proximal aneurysm neck diameter increase was determined by CT, increase over 2 mm as having change, less than 2 mm as no change. Results The average follow-up interval was (34 ± 25) months (ranging from 9 to 100 months). The mean preoperative proximal neck diameter was (21.5 ±2.3) mm, and (22.4 ± 2. 4) mm one month after operation and (24. 0 ±2. 8) mm at the latest follow-up. The increase of proximal neck diameter was detected in 71. 1% . The oversizing percentage was 19% ± 6% . The incidence of proximal neck over-sizing stent-graft in diameter was 6. 7%. The incidence of no dilation at proximal neck diameter was 97.4%, 68.6%, 39.3% and 3.3% at 16, 24, 36 and 96 months postoperatively respectively. The stent-graft migration was detected in 22. 2% patients, and the migration distance was (7. 0 ± 1. 3) mm (ranging from 0 to 9. 5 mm). There were no case which the migration oversized 10 mm or need to reintervention. Conclusions The more oversizing percentage, the more dilatation in the proximal neck. The stent-graft migration and the dilatation of the proximal neck might have effect on each other.     

Repair of recurrent visceral aortic patch aneurysm after thoracoabdominal aortic aneurysm repair with a branched endovascular stent graft

Aneurysmal degeneration of the visceral aortic patch is an uncommon late complication of surgical replacement of the thoracoabdominal aorta. We report on a 70-year-old woman who had undergone previous open thoracoabdominal aortic aneurysm repair and subsequent revision surgery for a visceral aortic patch aneurysm. The patient presented with a recurrent asymptomatic 60-mm-diameter visceral aortic patch aneurysm involving the celiac axis and superior mesenteric artery. The lesion was successfully treated with a custom-designed Zenith branched endovascular stent graft. The patient remains well at 12 months.     

Stent graft migration after endovascular aneurysm repair: importance of proximal fixation

OBJECTIVE: We reviewed the incidence of stent-graft migration after endovascular aneurysm repair in a prospective multicenter trial and identified factors that may predispose to such migration. METHODS: All patients who received treatment during the course of the multicenter AneuRx clinical trial were reviewed for evidence of stent-graft migration over 5 years, from 1996 to 2001. Post-deployment distance from the renal arteries to the proximal end of the stent graft and the proximal fixation length (length of the infrarenal neck covered by the stent graft) were determined in patients for whom pre-procedure and post-procedure computed tomography scans were measured in an independent core laboratory. RESULTS: Stent-graft migration was reported in 94 of 1119 patients, with mean time after device implantation of 30 +/- 11 months. Freedom from migration was 98.6% at 1 year, 93.4% at 2 years, and 81.2% at 3 years (Kaplan-Meier method). Subset (n = 387) analysis revealed that initial device deployment was lower in 47 patients with migration, as evidenced by a greater renal artery to stent-graft distance (1.1 +/- 0.7 cm), compared with 340 patients without migration (0.8 +/- 0.6 cm; P =.006) on post-implantation computed tomography scan. Proximal fixation length was shorter in patients with migration (1.6 +/- 1.4 cm) compared with patients without migration (2.3 +/- 1.4 cm; P =.005). There was significant variation in migration rate among clinical sites (P <.001), ranging from 0% to 30% (median, 8%), with a greater than twofold difference in migration rate between the lowest quartile (6%) and the highest quartile (15%) clinical sites. Univariate and multivariate analysis revealed that renal artery to stent-graft distance (P =.001) and proximal fixation length (P =.005) were significant predictors of migration, and that each millimeter increase in distance below the renal arteries increased risk for subsequent migration by 5.8% and each millimeter increase in proximal fixation length decreased risk for migration by 2.5%. Pre-implantation aortic neck length, neck diameter, degree of device oversizing, correct versus incorrect oversizing, device type (stiff vs flexible), placement of proximal extender cuffs at the original procedure, and post-procedure endoleak were not significant predictors of migration. Migration was treated with placement of extender modules in 23 patients and surgical conversion in 7 patients; 64 patients (68%) with migration have required no treatment. CONCLUSIONS: Stent-graft migration among patients treated in the AneuRx clinical trial appears to be largely related to low initial deployment of the device, below the renal arteries, and short proximal fixation length. Significant variation in migration rate among clinical sites highlights the importance of the technical aspects of stent-graft deployment. Advances in intraoperative imaging and deployment techniques that have been made since completion of the clinical trial facilitate precision of device placement below the renal arteries and should increase proximal fixation length. Whether this, together with increased iliac fixation length, will result in lower risk for migration remains to be determined in long-term follow-up studies.     

Follow-up of aneurysm neck diameter after endovascular repair of abdominal aortic aneurysms

We assessed aneurysm neck diameter change after endovascular abdominal aortic aneurysm repair (EVAR) and its relationship to stent-graft diameter. Ninety-eight patients with abdominal aortic aneurysm who underwent EVAR were studied with multislice computed tomography following a standardized protocol. A preoperative study and immediate postoperative, 6-month, 1-year, and 2-year follow-up studies were performed. The aneurysm neck was measured from adventitia to adventitia, 6 mm below the lowermost renal artery, in planar images performed perpendicular to the vessel axis (real axial section). Baseline and follow-up neck diameters were compared with stent-graft diameters. For statistical analysis, a one-way analysis of variance with repeated measures was used. Pearson's correlation coefficient was used to examine the correlation between the change in neck diameter and stent-graft diameter. The average neck diameter was 22.38 mm (range 16-32.5) on the preoperative study and 23.35 mm (17-33.9) on the immediate postoperative, 24.35 mm (18.2-34.5) on the 6-month, 24.36 mm (18-34.5) on the 1-year, and 24.39 mm (17.8-35.7) on the 2-year follow-up. The mean device diameter was 24.08 mm (20-32). A significant increase in average neck diameter was found between the preoperative, immediate postoperative control, and 6-month control. There was no significant increase in the average neck diameter between the 6-month, 1-year, and 2-year follow-up. Baseline mean stent-graft oversizing was 1.7 mm, which decreased to -0.31 mm at latest follow-up. Dilation of the neck did not significantly exceed the endograft diameter in 83 cases (87.36%). An enlargement of the infrarenal aneurysm neck occurred during the first 6 months after EVAR. No significant variation in neck diameter occurred between the 6-month and 2-year follow-up visits. In the majority of cases, dilation of the aneurysm neck does not significantly exceed stent-graft diameter and, therefore, is possibly related to the presence of the endograft.     

Clinical experience with a bifurcated endovascular graft for abdominal aortic aneurysm repair

Purpose: The purpose of this study was to test a transfemoral system of bifurcated endovascular graft insertion for aortic aneurysm repair.Methods: Bifurcated endovascular grafts were inserted through bilateral femoral artery cutdowns in 41 patients. The results were assessed by completion angiography and follow-up computed tomography.Results: The second half of the study included more aneurysms 6 cm or larger (p < 0.05) and more instances of short proximal neck (p < 0.05), proximal neck angulation (p < 0.05), and iliac angulation (p < 0.05). Despite the increasingly challenging anatomy, the results were better in the second half of the study as illustrated by the lower overall combined morbidity/mortality rate (15% vs 50%) and higher overall success rate (85% versus 65%). The mortality rate for the series as a whole was 7.5%. Mean follow-up was 18.8 months for the first 20 patients and 10.9 months for the second 20. The commonest complication in the first half of the study was graft thrombosis (n = 5). This complication was absent from the second half of the study because of routine adjunctive stenting. Two patients died of complications of endovascular repair. In both cases aneurysm rupture on the third postoperative day was associated with coagulopathy and angiographic signs of perigraft leak.Conclusion: Aneurysm exclusion with a bifurcated endovascular graft was feasible in a wide range of patients, but when the aneurysm was not entirely excluded from the circulation, the risk of rupture persisted. (J Vasc Surg 1996;24:655-66.)     

Fourteen-year outcomes of abdominal aortic endovascular repair with the Zenith stent graft

Objective

Long-term results of abdominal aortic aneurysm (AAA) endovascular repair are affected by graft design renewals that tend to improve the performance of older generation prostheses but usually reset the follow-up times to zero. The present study investigated the long-term outcomes of endovascular AAA repair (EVAR) using the Zenith graft, still in use without major modification, in a single center experience.

Endograft migration one to four years after endovascular abdominal aortic aneurysm repair with the AneuRx device: a cautionary note

BACKGROUND: Positional stability of the endograft is essential for long-term durability after endovascular abdominal aortic aneurysm repair (EAR). However, the cumulative risk of delayed endograft migration has been sparsely reported. METHOD: A total of 91 patients studied underwent EAR with the AneuRx endograft with a minimum 1 year from implantation. Data from a prospective database were assessed for proximal endograft migration, defined as > or = 5 mm change from the initial endograft position. Multiple anatomic characteristics were also examined. Sixty-nine patients were alive, with complete follow-up at 1 year, with a mean time from implantation of 33.2 +/- 1.1 months. Data are mean +/- SEM. RESULTS: Endograft migration occurred in 15 patients, giving a cumulative event rate of 7.2% (5/69) at 1 year, 20.4% (10/49) at 2 years, 42.1% (8/19) at 3 years, and 66.7% (2/3) at 4 years post-EAR (P =.01). Although the initial aortic neck diameter did not differ between the groups (21.5 +/- 0.6 mm vs 21.8 +/- 0.3 mm, P =.61), significant (P <.05), late aortic neck enlargement was seen in patients with migration (25.0 +/- 1.6 mm, 26.2 +/- 1.2 mm, and 27.0 +/- 1.0 mm at 1,2, and 3 years, respectively) but not in nonmigrators. Regression analysis demonstrated a statistically significant (P <.05) correlation between endograft oversizing and late aortic neck dilation. Overall migration risk was 29.2% in patients oversized >20% and 18.6% in patients oversized < or = 20%. Aortic neck angulation (23.4 +/- 6.6 degrees vs 23.5 +/- 3.3 degrees, P =.99), aortic neck length (25.9 +/- 2.5 mm vs 27.0 +/- 1.6 mm, P =.74), initial endograft/aortic neck overlap (18.6 +/- 2.6 mm vs 19.4 +/- 1.4 mm, P =.80) and size of abdominal aortic aneurysm (55.5 +/- 1.5 mm vs 54.9 +/- 1.4 mm, P =.84) were similar between migrators and nonmigrators, respectively. Secondary endovascular treatment with aortic cuffs was required in five patients with device migration. CONCLUSIONS: Device migration after EAR with the AneuRx endograft occurred with significant frequency, the incidence of which increased with the length of follow-up. Late aortic neck dilation was significantly associated with migration. Oversizing of the endograft of >20% may accelerate this late aortic neck dilation. However, the etiologies of endograft migration were likely multifactorial, as the majority (8/15) of patients experiencing migration were oversized <20%. Although endovascular repair of these migrations is usually possible, the long-term durability of these secondary procedures is unknown. Careful surveillance for this endograft failure mode must be an essential component of post-EAR follow-up.     

Mid- and long-term device migration after endovascular abdominal aortic aneurysm repair: a comparison of AneuRx and Zenith endografts

BACKGROUND: Freedom from migration is key to the durability of endovascular aneurysm repair (EVAR). This study evaluates the mid- and long-term incidence of migration with two different endografts. METHODS: Between September 1997 and June 2004, 235 patients were scheduled for EVAR with an AneuRx (Medtronic/AVE Inc.) or Zenith (Cook) endograft. Patients with fusiform, infrarenal aneurysms and a minimum 12 months of follow-up were analyzed, for a final cohort of 130 patients. Migration was assessed on axial computed tomography (CT) (2.5 to 3 mm cuts) as the distance from the most caudal renal artery to the first slice containing endograft (AneuRx) or to the top of the bare suprarenal stent (Zenith). Aortic neck diameters were measured at the most caudal renal artery. The initial postoperative CT scan was the baseline. Migration was defined by caudal movement of the endograft at two thresholds, > or =5 mm and > or =10 mm, or any migration with a related clinical event. RESULTS: Life-table analysis demonstrated AneuRx freedom from migration (> or =10 mm or clinical event) was 96.1%, 89.5%, 78.0%, and 72.0% at 1, 2, 3, and 4 years, respectively. Zenith freedom from migration was 100%, 97.6%, 97.6%, and 97.6% at 1, 2, 3, and 4 years, respectively (P = .01, log-rank test). The stricter 5-mm migration threshold found 67.4% of AneuRx and 90.1% of Zenith patients free from migration at 4 years of follow-up. Twelve out of 14 (85.7%) AneuRx patients (12/14) with migration (> or =10 mm or clinical event) underwent 14 related secondary procedures (13 endovascular, 1 open conversion). The single Zenith patient with migration (> or =10 mm) has not required adjuvant treatment. Mean follow-up was 39.0 +/- 2.3 months (AneuRx) and 30.8 +/- 1.9 months (Zenith, P = .01). Patients with and without migration did not differ in age, gender ratio, aneurysm diameter, and neck diameter. However, initial neck length was shorter in patients with migration (22.1 +/- 2.1 mm vs 31.2 +/- 1.2 mm, P = .02). A subset of patients (21.6%) experienced significant (defined as > or =3 mm) maximum aortic neck dilation. Of the AneuRx patients, > or =3 mm aortic neck dilation affected 30.8% of migrators vs 13.0% of nonmigrators (P = .20). CONCLUSIONS: Endograft migration is a time-dependent phenomenon affected by both device choice and aortic neck length. A great majority of patients (85.7%) with migration of the AneuRx device ultimately required treatment. A minority of patients experienced aortic neck dilation that could be considered clinically significant. Careful surveillance for migration is an essential component of long-term follow-up after EVAR.     

Aortic neck dilatation after endovascular abdominal aortic aneurysm repair: a word of caution

Continuing aortic neck dilatation, most probably an expression of ongoing aneurysmal wall degeneration of the infrarenal aortic segment, has been shown to seriously impair clinical results after endovascular abdominal aortic aneurysm repair. However, conflicting data on the extent and clinical relevance on this observation have recently been published. This article reviews the recent literature, summarizing our current understanding of the role of aortic neck dilatation after open surgical and endovascular abdominal aortic aneurysm repair. In addition, differences in methodology of studies on aortic neck dilatation are highlighted.