Endograft migration one to four years after endovascular abdominal aortic aneurysm repair with the AneuRx device: A cautionary note

Background: Positional stability of the endograft is essential for long-term durability after endovascular abdominal aortic aneurysm repair (EAR). However, the cumulative risk of delayed endograft migration has been sparsely reported. Method: A total of 91 patients 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 greater than or equal to5 mm change from the initial endograft position. Multiple anatomic characteristics were also examined. Sixty-nine patients 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 patients, 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 aortic neck enlargement was seen in patients with migration (25.0 +/- 1.6 mm, 26.2 +/- 1.2 mm, and 27.0 +/- 1.0 min 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 aortic neck dilation. Overall migration risk was 29.2% in patients oversized >20% and 18.6% in patients oversized less than or equal to20%. Aortic neck angulation (23.4 +/- 6.6 degrees vs 23.5 +/- 3.3 degrees, P = .99), aortic neck length (25.9 +/- 2.5 mm vs 27.0 +/- 1.6 mm, P = .74), initial endograft/aortic neck overlap (18.6 +/- 2.6 mm vs 19.4 +/- 1.4 mm, P = .80) and size of abdominal aortic aneurysm (55.5 +/- 1.5 mm vs 54.9 +/- 1.4 min, P = .84) were similar between migrators and nonmigrators, respectively. Secondary endovascular treatment with aortic cuffs was required in five patients with device migration. Conclusions: Device migration after EAR with the AncuRx endograft occurred with significant frequency, the incidence of which increased with the length of follow-up. Late aortic neck dilation was significantly associated with migration. Oversizing of the endograft of >20% may accelerate this late aortic neck dilation. However, the etiologies of endograft migration were likely multifactorial, as the majority (8/15) of patients 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.