Aortic neck evolution after endovascular repair with TriVascular Ovation stent graft

Gianmarco De Donato, Francesco Setacci, Luciano Bresadola, Patrizio Castelli, Roberto Chiesa, Nicola Mangialardi, Giovanni Nano, Carlo Setacci, Carmelo Ricci, Daniele Gasparini, Gianluca Piccoli, Andrea Kahlberg, Silvia Stegher, Gianpaolo Carrafiello, Nicola Rivolta, Claudio Novali, Carlo Rivellini, Massimo Lenti, Giacomo Isernia, Sonia RonkeyRocco Giudice, Francesco Speziale, Pasqualino Sirignano, Giustino Marcucci, Federico Accrocca, Pietro Volpe, Francesco Talarico, Gaetano La Barbera

Research output: Contribution to journalArticlepeer-review

Abstract

Objective 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.

Original languageEnglish
Pages (from-to)8-15
Number of pages8
JournalJournal of Vascular Surgery
Volume63
Issue number1
DOIs
Publication statusPublished - Jan 1 2016

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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