The Association between Iliac Fixation and Proximal Stent-graft Migration during EVAR Follow-up: Mid-term Results of 154 Talent Devices

Objective: This study investigated the importance of iliac fixation to secure endograft fixation. Materials and methods: Computed tomography (CT) scans of patients who underwent endovascular aneurysm repair with an endoprosthesis of great columnar strength (Talent (TM) stent graft) were analysed retrospectively. Patients were enrolled consecutively between June 2000 and January 2007 and prospectively followed up with serial CT imaging. The superior mesenteric artery was used as a reference point to determine endograft migration (centerline endograft displacement of >= 10 mm). Proximal and distal fixation lengths were defined as the length of the endograft that was in full apposition to the aortic neck or common iliac arteries, respectively. Results: Proximal endograft migration occurred in 32 of 154 patients (21%) at a follow-up duration of 32 +/- 14 months; 13 migrations required treatment (8%). Migration was more frequent in patients treated with aorto-uniiliac devices than bifurcation devices (p < 0.008). The migrator and non-migrator groups had similar demographic and abdominal aortic aneurysm (AAA) characteristics. The migrator group had significantly shorter proximal (30 +/- 12 mm vs. 41 +/- 13 mm, P < 0.001) and distal endograft fixation lengths (31 +/- 18 mm vs. 47 +/- 15 mm, P < 0.001). By multivariate regression analysis, proximal and distal endograft fixations were significant predictors for endograft migration at follow-up (P < 0.001). Conclusion: Iliac endograft fixation, along with proximal fixation, is a significant predictor for endograft migration. (C) 2009 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.