title: Endograft accommodation on the aortic bifurcation: an overview of anatomical fixation and implications for long-term stent-graft stability.
abstract: In light of the results of randomized trials, it seems that despite the favorable short and midterm outcomes of standard endografts, concern over endograft migration has escalated, as this event will be responsible for almost all late complications in endovascular aneurysm repair (EVAR). Migration forces, both caudal and sideways, depend heavily on blood pressure, inlet diameter, and angulation of the stent-graft, while the bifurcation generates more force than any other segment of the stent-graft. It thus seems that the position of the endograft's flow divider influences force distribution and migration risk. Additionally, due to concomitant ongoing aortic degeneration, postoperative dilatation of the infrarenal aortic neck poses a threat to EVAR patients as soon as the diameter of the infrarenal neck reaches the dimensions of the proximal graft. This review evaluates the significance of endograft accommodation on the aortic bifurcation and cumulative experience of the only endografts utilizing this feature: the Zenith Composite and the Powerlink.
authors.affiliation: Department of Vascular Surgery, Attikon University Hospital, Medical School of Athens, Athens, Greece. efavgerinos@gmail.com
authors.forename: Efthimios D
authors.initials: ED
authors.lastname: Avgerinos
authors.forename: Ilias
authors.initials: I
authors.lastname: Dalainas
authors.forename: John
authors.initials: J
authors.lastname: Kakisis
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Moulakakis
authors.forename: Triantafillos
authors.initials: T
authors.lastname: Giannakopoulos
authors.forename: Christos D
authors.initials: CD
authors.lastname: Liapis
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D005548:Foreign-Body Migration / Q000209:etiology / Q000517:prevention & control*; D006439:Hemodynamics; D006801:Humans; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013314:Stress, Mechanical; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome