In light of the results of randomized trials, it seems that despite the favorable
short and midterm outcomes of standard endografts, concern over endograft
migration has escalated, as this event will be responsible for almost all late
complications in endovascular aneurysm repair (EVAR).
Migration forces, both caudal and sideways, depend heavily on blood pressure,
inlet diameter, and angulation of the stent-graft, while the bifurcation
generates more force than any other segment of the stent-graft. It thus seems
that the position of the endograft's flow divider influences force
distribution and migration risk. Additionally, due to concomitant ongoing aortic
degeneration, postoperative dilatation of the infrarenal aortic neck poses a
threat to EVAR patients as soon as the diameter of the infrarenal neck reaches
the dimensions of the proximal graft.
This review evaluates the significance of endograft accommodation on the aortic
bifurcation and cumulative experience of the only endografts utilizing this
feature: the Zenith Composite and the Powerlink.
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