Stent graft migration after endovascular aneurysm repair: importance of proximal fixation Christopher K Zarins, MD, Daniel A Bloch, PhD, Tami Crabtree,

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Stent graft migration after endovascular aneurysm repair: importance of proximal fixation Christopher K Zarins, MD, Daniel A Bloch, PhD, Tami Crabtree, MS, Alan H Matsumoto, MD, Rodney A White, MD, Thomas J Fogarty, MD Journal of Vascular Surgery Volume 38, Issue 6, Pages 1264-1272 (December 2003) DOI: 10.1016/S0741-5214(03)00946-7

Fig 1 Proximal fixation length calculated by subtracting axial distance from lowermost renal artery to top of stent graft from axial distance from lowermost renal artery to beginning of aneurysm. Neck angulation was not measured, and can influence effective fixation length (far right). Journal of Vascular Surgery 2003 38, 1264-1272DOI: (10.1016/S0741-5214(03)00946-7)

Fig 2 Kaplan-Meier analysis of freedom from migration. In interval from 24 months to 36 months, 427 patients were at risk at start of the interval (24 months) and 135 patients were at risk at end of the interval (36 months). Journal of Vascular Surgery 2003 38, 1264-1272DOI: (10.1016/S0741-5214(03)00946-7)

Fig 3 Migration and stent graft oversizing. Oversizing is defined as percent difference between preoperative aortic neck diameter and diameter of proximal stent graft. Journal of Vascular Surgery 2003 38, 1264-1272DOI: (10.1016/S0741-5214(03)00946-7)

Fig 4 Rank order of migration at 13 Phase II clinical sites. There was no relation between number of patients treated at each site and migration rate. Journal of Vascular Surgery 2003 38, 1264-1272DOI: (10.1016/S0741-5214(03)00946-7)

Fig 5 AneuRx stent graft placed during clinical trial, with complete aneurysm exclusion and no endoleak. Left, Low positioning of stent graft in aortic neck, with short proximal fixation length and short iliac fixation length, are evident on post-implantation CT scan (three-dimensional reconstruction). Right, Stent-graft migration with development of type I endoleak and aneurysm enlargement, noted at 23 months, were successfully treated with placement of proximal and distal extender cuffs. Current recommended clinical practice is to achieve fixation at initial endovascular treatment by positioning the device just below the renal arteries and using iliac modules, as needed, to extend the device to the level of the hypogastric arteries. Journal of Vascular Surgery 2003 38, 1264-1272DOI: (10.1016/S0741-5214(03)00946-7)

Fig 5 AneuRx stent graft placed during clinical trial, with complete aneurysm exclusion and no endoleak. Left, Low positioning of stent graft in aortic neck, with short proximal fixation length and short iliac fixation length, are evident on post-implantation CT scan (three-dimensional reconstruction). Right, Stent-graft migration with development of type I endoleak and aneurysm enlargement, noted at 23 months, were successfully treated with placement of proximal and distal extender cuffs. Current recommended clinical practice is to achieve fixation at initial endovascular treatment by positioning the device just below the renal arteries and using iliac modules, as needed, to extend the device to the level of the hypogastric arteries. Journal of Vascular Surgery 2003 38, 1264-1272DOI: (10.1016/S0741-5214(03)00946-7)