title: Detection of broken sutures and metal-ring fractures in AneuRx stent-grafts by using three-dimensional CT angiography after endovascular abdominal aortic aneurysm repair: association with late endoleak development and device migration.
abstract: OBJECTIVE
  To determine the prevalence of demonstrable stent-graft degradation by using three-dimensional computed tomographic (CT) angiography to assess endoleak and stent-graft migration after endovascular aortic aneurysm repair (EVAR).
  
  
  METHODS
  The institutional review board approved this retrospective study. Sixty-two consecutive patients with abdominal aortic aneurysm treated with the AneuRx stent-graft (Medtronic, Santa Rosa, Calif) were assessed between 0.5 and 9.5 years after EVAR (median, 5.1 years) for the presence of broken attachment sutures and metal-ring fractures by using CT angiography. The relative risk (RR) of delayed endoleak formation and endograft migration was calculated relative to the presence of suture breaks and metal-ring fractures. A two-tailed Fisher exact test was used to assess significant differences.
  
  
  RESULTS
  Suture breaks were observed in 55 of 62 subjects (89%), including 37 minor breaks (60%) and 18 major breaks (29%). Metal-ring fractures were observed in 11 of 62 subjects (18%). Twenty-seven endoleaks were observed in 24 of 62 subjects (39%) and were categorized as type I in seven of 27 (11%), type II in 16 of 27 (26%), and type III in four of 27 (6%). Major suture breaks were associated with six of seven (86%) delayed type I endoleaks (RR = 19.4, P = .003), and metal-ring fractures were associated with four of seven (57%) delayed type I endoleaks (RR = 6.2, P = .015) and three of four (75%) type III endoleaks (RR = 13.9, P = 003). Migration was observed in 15 of 62 patients (24%) and was associated with major suture breaks in 10 of 15 patients (67%, RR = 4.5, P = .001) and with metal-ring fractures in five of 11 patients (45%, RR = 4.1, P = .003). Repeat interventions were performed in 15 patients.
  
  
  CONCLUSIONS
  Major suture breaks and metal-ring fractures are demonstrated with CT and are associated with delayed type I and III endoleaks and with stent-graft migration after EVAR.
authors.affiliation: From the Department of Radiology, Stanford University School of Medicine, Stanford, Calif, and Department of Radiology, St Luke's International Hospital, 9-1 Akashi cho, Chuo-ku, Tokyo 104-8560, Japan (T.U.); Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan (H.T.); Northern Virginia Radiology Consultants, Arlington, Va (I.P.); and Department of Radiology, Duke University Medical Center, Durham, NC (G.D.R.).
authors.forename: Takuya
authors.initials: T
authors.lastname: Ueda
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takaoka
authors.forename: Ivan
authors.initials: I
authors.lastname: Petrovitch
authors.forename: Geoffrey D
authors.initials: GD
authors.lastname: Rubin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D057867:Endoleak / Q000000981:diagnostic imaging*; D005260:Female; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D013537:Sutures / Q000009:adverse effects*