The choice of stent-graft for endovascular repair of abdominal aortic aneurysm.
The aim of this study was to explain variations in the results of endovascular aneurysm repair as a consequences of device design. Low profile, trackable systems, such as Zenith and Excluder, rarely fail to traverse the iliac arteries, even in the presence of iliac tortuosity or stenosis. In most patients, optimal sizing is only possible with systems, such as Zenith, Talent, and Quantum lp, that have a wide range of diameters. Short, angulated necks call for a high degree of flexibility and secure, barb-enhanced proximal fixation, which are features of Excluder, Zenith and Ancure. The main risk factors for rupture are migration, type III endoleak, and aneurysm dilatation. Migration rates are high for devices, such as AneuRx, that have neither barbs nor suprarenal stents. Aneurysm shrinkage occurs at high rates with non-porous stent-grafts, such as Zenith, Talent, and Ancure, but at far lower rates with porous stent-grafts, such as Excluder and AneuRx. Type III endoleak, due to fabric failure or component separation, was a common failure mode for the Vanguard device, but is rare with newer devices. Suture breakage, barb separation and stent breakage occur frequently, yet clinical consequences, such as endoleak or rupture, are rare. Graft thrombosis is also unusual when the prostheses is fully-stented. In conclusion, modern devices are more versatile, more effective, and more durable than their first generation counterparts.
Chuter
T A M
TA
Department of Surgery, University of California, San Francisco, CA 94143, USA. chutert@surgery.ucsf.edu
D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D004868:Equipment Failure; D005548:Foreign-Body Migration; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D011474:Prosthesis Design; D011475:Prosthesis Failure; D015607:Stents / Q000009:adverse effects