12-year Experience with the Endologix Powerlink Device in Endovascular Repair of Abdominal Aortic Aneurysms

Since Parodi reported the first successful endovascular aneurysm repair procedure in 1991, this procedure has gained wide acceptance for the treatment of abdominal aortic aneurysms in the past two decades. This minimally invasive approach has been proven effective and safe in the treatment of abdominal aortic aneurysm patients with lower early morbidity and mortality rates compared to open surgery repair. Meanwhile, dozens of endografts have been designed for endovascular aneurysm repair, and most of them are now still undergoing modification and improvement. Although these devices have been improved over time, secondary procedures are required in up to 27% of patients following endovascular aneurysm repair. Complications of stent-graft migration, endoleaks, stent rupture/fracture, aortic neck dilatation and development of other aortoiliac aneurysms mandate lifelong patient follow-up. Among these complications the most prevalent and concerning complications are distal migration (defined by the Society for Vascular Surgery as device movement of greater than 10 mm or lesser device movement necessitating secondary intervention) and Type I endoleak, putting the patients under an increasing risk of aneurysm rupture. Migration has a reported incidence of up to 45%, and has been shown in biomechanical analyses to be the result of both persistent downward flow upon the stent-graft bifurcation (affecting neck fixation), and transverse forces, resulting in device lateral movement (affecting neck fixation, component stability, and iliac fixation). Type I endoleak is closely associated with migration, and is certainly the most significant predictor of aneurysm increase, risk of rupture, and need for secondary intervention or open conversion repair. Therefore, the most favorable design of endovascular aneurysm repair endograft should theoretically support to counteract the downward force of pulsatile blood flow and possibly prevent distal migration. Now on the market most of the endovascular aneurysm repair endografts are modular devices and deployed from proximal to distal. The Endologix