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. 2010 Aug;52(2):303-7.
doi: 10.1016/j.jvs.2010.03.018.

Long-term follow-up of neck expansion after endovascular aortic aneurysm repair

Thomas S Monahan  1 , Timothy A M Chuter, Linda M Reilly, Joseph H Rapp, Jade S Hiramoto
Affiliations

Long-term follow-up of neck expansion after endovascular aortic aneurysm repair

Thomas S Monahan et al. J Vasc Surg. 2010 Aug.

Abstract

Objective: This study determined the rate, extent, and clinical significance of neck dilatation after endovascular aneurysm repair (EVAR).

Methods: The study included 46 patients who underwent elective EVAR using bifurcated Zenith stent grafts (Cook, Bloomington, Ind) and had at least 48 months of clinical and radiographic follow-up. Computed tomography images were analyzed on a 3-dimensional workstation (TeraRecon, San Mateo, Calif). Neck diameter was measured 10 mm below the most inferior renal artery in planes orthogonal to the aorta. Nominal stent graft diameter was obtained from implantation records.

Results: Median follow-up was 59 months (range, 48-120 months). Neck dilation occurred in all 46 patients. The rate of neck dilation was greatest at early follow-up intervals. At 48 months, median neck dilation was 5.3 mm (range, 2.3-9.8 mm). The extent of neck dilation at 48 months correlated with percentage of stent graft oversizing (Spearman rho = 0.61, P < .001). No type I endoleak or migration >5 mm occurred.

Conclusions: After EVAR with the Zenith stent graft, the neck dilates until its diameter approximates the diameter of the stent graft. Neck dilation was not associated with type I endoleak or migration of the stent graft.

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Figures

Figure 1
Figure 1
Measurement of proximal aneurysm neck. The level of the most inferior renal artery was identified in the axial (Panel A), coronal (Panel B), and sagital planes (Panel C). The aortic neck was measured 10 mm inferior to the most inferior renal artery in planes orthogonal to the aorta, in the mid portion of the first covered stent (Panel D).
Figure 2
Figure 2
Rate (mm/month) of proximal neck dilation after EVAR (mean ± standard deviation).
Figure 3
Figure 3
Relationship between the percentage of endograft oversizing and amount of proximal neck dilation at 48-months of follow-up.
Figure 4
Figure 4
Normalized aortic neck diameter (aortic neck diameter/nominal stent graft diameter) over time.
See this image and copyright information in PMC

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