Anatomical Risk Factors for Proximal Perigraft Endoleak and Graft Migration Following Endovascular Repair of Abdominal Aortic Aneurysms

Introduction: proximal perigraft endoleak (PPE) and graft migration are associated with significant morbidity and mortality. Objective data establishing correlation between neck anatomy and these complications are lacking. The aim of this study was to analyse the anatomy of the neck in order to find which variables were significantly associated with PPE and graft migration. Methods: one hundred and eighty-four patients underwent endovascular repair (EVR) of infrarenal AAA using an in-house custom-made stent graft (Gianturco stents plus Dacron). Thirty-one patients had PPE and fifteen had graft migration. Neck diameter was measured at the level of renal arteries and lower limit of the neck. Necks were classified according to shape. Neck angulation was measured from spiral computed tomography (CT) or magnetic resonance imaging (MRI) reconstructions, or angiograms. Thrombus or atheroma lining and presence of calcifications were recorded. Results: neck angulation was significantly greater in patients who had PPE (50±16, p=0.0005) or graft migration (54±20, p=0.003), compared to patients who had none of these two complications (37±18). Neck diameter was significantly greater in patients with PPE (p=0.05). Incidence of PPE or graft migration was not significantly higher in the presence of a conical shape, thrombus or atheroma lining and calcifications. Conclusion: neck angulation was the risk factor most significantly related to PPE and graft migration.