Endograft migration one to four years after XXXX repair with the AneuRx device: a cautionary note.

@entity1 @entity135 @entity384 @entity1028
BACKGROUND: Positional stability of the endograft is essential for long-term durability after @entity1028 repair (EAR). However, the cumulative risk of delayed endograft migration has been sparsely reported. METHOD: A total of 91 @entity1 studied underwent EAR with the AneuRx endograft with a minimum 1 year from implantation. Data from a prospective database were assessed for proximal endograft migration, defined as > or = 5 mm change from the initial endograft position. Multiple anatomic characteristics were also examined. Sixty-nine @entity1 were alive, with complete follow-up at 1 year, with a mean time from implantation of 33.2 +/- 1.1 months. Data are mean +/- SEM. RESULTS: Endograft migration occurred in 15 @entity1 , giving a cumulative event rate of 7.2% (5/69) at 1 year, 20.4% (10/49) at 2 years, 42.1% (8/19) at 3 years, and 66.7% (2/3) at 4 years post-EAR (P =.01). Although the initial aortic neck diameter did not differ between the groups (21.5 +/- 0.6 mm vs 21.8 +/- 0.3 mm, P =.61), significant (P <.05), late @entity135 was seen in @entity1 with migration (25.0 +/- 1.6 mm, 26.2 +/- 1.2 mm, and 27.0 +/- 1.0 mm at 1,2, and 3 years, respectively) but not in nonmigrators. Regression analysis demonstrated a statistically significant (P <.05) correlation between endograft oversizing and late @entity384 . Overall migration risk was 29.2% in @entity1 oversized >20% and 18.6% in @entity1 oversized < or = 20%. @entity135 (23.4 +/- 6.6 degrees vs 23.5 +/- 3.3 degrees, P =.99), @entity135 (25.9 +/- 2.5 mm vs 27.0 +/- 1.6 mm, P =.74), @entity135 (18.6 +/- 2.6 mm vs 19.4 +/- 1.4 mm, P =.80) and size of @entity1028 (55.5 +/- 1.5 mm vs 54.9 +/- 1.4 mm, P =.84) were similar between migrators and nonmigrators, respectively. Secondary endovascular treatment with aortic cuffs was required in five @entity1 with device migration. CONCLUSIONS: Device migration after EAR with the AneuRx endograft occurred with significant frequency, the incidence of which increased with the length of follow-up. Late @entity384 was significantly associated with migration. Oversizing of the endograft of >20% may accelerate this late @entity384 . However, the etiologies of endograft migration were likely multifactorial, as the majority (8/15) of @entity1 experiencing migration were oversized <20%. Although endovascular repair of these migrations is usually possible, the long-term durability of these secondary procedures is unknown. Careful surveillance for this endograft failure mode must be an essential component of post-EAR follow-up.
