Abstract
Purpose: To report the incidence of delayed com plications following
endovascular abdominal aortic aneurysm (AAA) repair and the relationship
of these sequelae to morphological changes in the sac and endograft.
Methods:Twenty-six AAA patients treated with Vanguard endografts
had completed greater than or equal to 1-year follow-up. Postoperative
angiograms and spiral computed tomographic (CT) scans with 3-dimensional
reconstruction were compared to the 1-year images to determine morphological
changes in the aneurysm sac a nd the endograft. These changes were
then related to complications occurring between 1 and 12 months postoperatively
in the study group. Results: Comparison of angiograms uncovered endograft
buckling in 18 (69\%) patients and acutely angled or kinked endografts
in 10 (38\%). Measurements from the CT scans found that undistorted
endografts had a mean change in sac length of +6.6 mm. Mean sac length
change in buckled endografts was -3.1 mm, while kinked endografts
displayed a mean change of -6.2 mm (p < 0.002, Student's t-test).
Five (19\%) patients, all with distorted endografts, demonstrated
late (1 to 12 months) complications (4 endoleaks and 1 graft limb
thrombosis) owing to component separation, distal stent migration,
and acute angulation. No movement in the proximal stent was observed.
Elongation of the endograft (flow line measurement) was observed
in one tube graft only. Conclusions: In this study, longitudinal
shrinkage of the sac following endovascular aortic aneurysm repair
led to buckling or kinking of the endograft within 1 year in 69\%
of patients. This appears to be an important source of delayed complications.
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