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 ass ociated with significant morbidity and mortality. Objective data establishi ng correlation between neck anatomy and these complications nle lacking. Th e nim 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 (Giantur co stents plus Dacron). Thirty-one patients had PPE and fifteen had graft m igration. Neck diameter was measured at the level of renal arteries and low er limit of the neck. Necks were classified according to shape. Neck angula tion was measured from spiral computed tomography (CT) ol magnetic resonanc e 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 pati ents who had none of these two complications (37+/-18). Neck diameter was s ignificantly greater in patients with PPE (p=0.05). Incidence of PPE ol gra ft migration ic,as not significantly higher in the presence of a conical sh ape, thrombus or atheroma lining and calcifications. Conclusion: neck angulation was the risk factor most significantly related to PPE and graft migration.