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A multicentre investigation into migration of the Zenith fenestrated aortic stent-graft

A multicentre investigation into migration of the Zenith fenestrated aortic stent-graft. England A , García-Fiñana M, McWilliams RG & British Society for Endovascular Therapy (BSET) Collaborators. Financial Disclosure. Funding – NIHR grant. BACKGROUND. Complications AAA reperfusion

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A multicentre investigation into migration of the Zenith fenestrated aortic stent-graft

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  1. A multicentre investigation into migration of the Zenith fenestrated aortic stent-graft England A, García-Fiñana M, McWilliams RG & British Society for Endovascular Therapy (BSET) Collaborators.

  2. Financial Disclosure • Funding – NIHR grant.

  3. BACKGROUND • Complications • AAA reperfusion • Vessel occlusion • Rupture • Maintaining fixation • Radial force • Hooks & barbs • Longitudinal columnar support • Suprarenal component • Target vessel stents • Displacement (drag) force

  4. AIM To report using multicentre data the:- • Incidence • Timings • Related complications/reinterventions Proximal & distal(Iliac limb) migration of Zenith fenestrated AAA stent-graft.

  5. METHODS • Nine UK Centres approached • Inclusion Criteria • FEVAR – Zenith (Cook) • CT Follow-up • 1st post-op CT scan (baseline) • +1 additional CT scan (> 6 months) • Endovascular databases • Sample description • Follow-up events (+CT data) • Ethics, R&D approvals • Retrieval of CT data to Liverpool

  6. MIGRATION DEFINITION • Movement of the device by ≥ 4 mm at either proximal or distal (iliac) landing zones1. England et al., J VascSurg 2012;55:895-905

  7. PROXIMAL DISTAL 1-MONTH CT (Baseline) 1-MONTH CT (Baseline) SAGITTAL CLL TOP STENT SMA BOTTOM STENT 6 mm EIA 24 mm 2 mm CRANIAL CAUDAL 2-YEAR CT ANNUAL CT 7 mm SAGITTAL CLL TOP STENT BOTTOM STENT SMA 8 mm 17 mm

  8. RESULTS 154 59%

  9. DEVICES

  10. PROXIMAL MIGRATION ≥ 4 mm • In 33 patients (21%) - caudal • Median migration +6 mm (range, +4.1 to +10.0 mm) • One migration per 10 person-years of follow-up • Median time to migration = 12 months (range 6 to 89 months) ≥

  11. FREEDOM FROM PROXIMAL MIGRATION 82% 77% 77% 64%

  12. DISTAL (iliac) MIGRATION ≥ 4 mm • Out of 259 iliac limbs assessed • 34 (13%) showed migration (cranial) • Median migration -6.1 mm (range, -4.1 to -17.8 mm) • One limb migration per 9.9 person-years of follow-up • Median time to migration = 23 months (range 6 to 89 months)

  13. RESULTSFREEDOM FROM DISTAL MIGRATION IPSILATERAL LIMB CONTRALATERAL LIMB

  14. RESULTSFREEDOM FROM ANY DISTAL MIGRATION 85% 82% 65% 65%

  15. COMPLICATIONS REINTERVENTIONS

  16. CONCLUSIONS • Based on this multicentre analysis:- • Migration • Proximal, • Distal (iliac), • Movements • Minor (< 7 mm) • Consequences • Minimal } patients at 4years

  17. COLLABORATORS This project would not have been possible without the support from:- • St. George’s Vascular Institute • Cambridge University Hospitals • Manchester Royal Infirmary • University Hospitals of South Manchester • Newcastle University Hospitals • Royal Liverpool University Hospital • Royal United Hospital Bath • University Hospitals of Leicester • Royal Free Hospital

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