Aortic neck evolution after endovascular repair with TriVascular Ovation stent graft

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• 作者：Gianmarco de Donato ; MD^a ; ^{dedonato@unisi.it" class="auth_mail" title="E-mail the corresponding author} ; Francesco Setacci ; MD^b ; Luciano Bresadola ; MD^c ; Patrizio Castelli ; MD^d ; Roberto Chiesa ; MD^e ; Nicola Mangialardi ; MD^f ; Giovanni Nano ; MD^g ; Carlo Setacci ; MD^a ; TriVascular Ovation Italian StudyCarlo Setacci ; Gianmarco de Donato ; Carmelo Ricci ; Daniele Gasparini ; Gianluca Piccoli ; Roberto Chiesa ; Andrea Kahlberg ; Giovanni Nano ; Silvia Stegher ; Patrizio Castelli ; Gianpaolo Carrafiello ; Nicola Rivolta ; Claudio Novali ; Carlo Rivellini ; Massimo Lenti ; Giacomo Isernia ; Nicola Mangialardi ; Sonia Ronkey ; Rocco Giudice ; Francesco Speziale ; Pasqualino Sirignano ; Luciano Bresadola ; Giustino Marcucci ; Federico Accrocca ; Pietro Volpe ; Francesco Talarico ; Gaetano La Barbera
• 刊名：Journal of Vascular Surgery
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：63
• 期：1
• 页码：8-15
• 全文大小：1076 K

文摘

Aortic neck dilation has been reported after endovascular aneurysm repair (EVAR) with self-expanding devices. With a core laboratory analysis of morphologic changes, this study evaluated midterm results of aortic neck evolution after EVAR by endograft with no chronic outward force.

Methods

This was a multicenter registry of all patients undergoing EVAR with the Ovation endograft (TriVascular, Santa Rosa, Calif). Inclusion criteria were at least 24 months of follow-up. Standard computed tomography (CT) scans were reviewed centrally using a dedicated software with multiplanar and volume reconstructions. Proximal aortic neck was segmented into zone A (suprarenal aorta/fixation area), zone B (infrarenal aorta, from lowest renal artery to the first polymer-filled ring), and zone C (infrarenal aorta, at level of the first polymer-filled ring/sealing zone). Images were analyzed for neck enlargement (≥2 mm), graft migration (≥3 mm), endoleak, barb detachment, neck bulging, and patency of the celiac trunk and superior mesenteric and renal arteries.

Results

Inclusion criteria were met in 161 patients (mean age, 75.2 years; 92% male). During a mean follow-up period of 32 months (range, 24-50), 17 patients died (no abdominal aortic aneurysm-related death). Primary clinical success at 2 years was 95.1% (defined as absence of aneurysm-related death, type I or type III endoleak, graft infection or thrombosis, aneurysm expansion >5 mm, aneurysm rupture, or conversion to open repair). Assisted primary clinical success was 100%. CT scan images at a minimum follow-up of 2 years were available in 89 cases. Patency of visceral arteries at the level of suprarenal fixation (zone A) was 100%. Neither graft migration nor barb detachment or neck bulging was observed. None of the patients had significant neck enlargement. The mean change in the diameter was 0.18 ± 0.22 mm at zone A, −0.32 ± 0.87 mm at zone B, and −0.06 ± 0.97 mm at zone C. Changes at zone B correlated significantly with changes at zone C (correlation coefficient, 0.183; P = .05), whereas no correlation was found with zone A (correlation coefficient, 0.000; P = 1.0).

Conclusions

No aortic neck dilation occurred in this series at CT scan after a minimum 24-month follow-up. This may suggest that aortic neck evolution is not associated with EVAR at midterm follow-up when an endograft with no chronic outward radial force is implanted.