Stent Graft Rotation During Advanced EVAR Increases Risk of Postoperative Complications


Submitted on Sat, 07/28/2018 - 10:00
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According to a prospective study in the Journal of Vascular Surgery, patients with stent graft rotation during advanced endovascular aortic aneurysm repair (EVAR) are more likely to experience severe complications following intervention.

The researchers also noted that higher levels of calcification, iliac artery torsion, and stent graft length were the greatest predictive factors for stent graft rotation in these patients.

Investigators enrolled patients undergoing advanced EVAR at 2 university-affiliated hospitals (n = 39) and measured stent graft rotation on intraoperative fluoroscopic video assessment of the deployment sequence. In the study, the researchers defined stent graft rotation as a rotation in the stent graft orientation of ≥10 degrees. 

The researchers collected data on operative time, fluoroscopy time, volume of injected contrast dye, and postoperative in-hospital as well as 30-day complications. In addition, the primary clinical endpoint was comprised of a composite outcome of any end-organ ischemia or mortality. 

Approximately 37% (n = 14) of patients undergoing advanced EVAR experienced intraoperative stent graft rotation (mean rotation, 25 degrees [interquartile range, 21-28 degrees]). The primary clinical endpoint of the composite outcome of any end-organ ischemia or death was met in a greater proportion of patients with vs without stent graft rotation (36% vs 0%, respectively; P =.004). Iliac artery torsion, iliac artery calcification volume, and stent graft length represented the primary predictors for rotation in the nominal logistic regression model.

Patients with stent graft rotation had significantly greater total net torsion (8.9 ± 0.8 mm-1 vs 4.1 ± 0.5 mm-1) and total volume of calcific plaque (1054 ± 144 mm3 vs 525 ± 83 mm3) than those without intraoperative rotation. Additionally, patients with stent graft rotation had greater lengths of implanted stent grafts (172 ± 9 mm vs 156 ± 8 mm). Finally, combined rates of type Ib and type III endoleaks were significantly greater in patients with rotation vs without rotation (43% vs 8%, respectively).

The study’s small sample size as well as its lack of longitudinal follow-up represent its primary limitations.

“Once prospectively validated, this predictive model could provide important preoperative information for both the clinician and the patient,” the authors wrote. “At the simplest level, this model could be used to augment the current preoperative risk assessment to allow patients and clinicians to make a more informed decision about treatment of the aneurysm.”

- Written by Brandon May


Crawford SA, Sanford RM, Doyle MG, et al. Prediction of advanced endovascular stent graft rotation and its associated morbidity and mortality. Journal of Vascular Surgery. 2018;68(2):348-355.