ALTURA™ Stent Graft Shortening and Its Implications After EVAR

Objectives: The ALTURA™ stent graft system is designed for the treatment of abdominal aortic and/or aorto-iliac aneurysms. This study evaluates the performance of the ALTURA™ stent graft, focusing on AAA diameter, landing zones, stent graft length, and migration following endovascular aortic repair (EVAR). Methods: This is a retrospective analysis of computed tomography (CT) images focuses on patients with infrarenal abdominal aortic aneurysm (AAA) treated with the ALTURA™ stent graft system (Lombard, Ltd., Didcot, UK) at Pauls Stradins Clinical University Hospital in Riga, Latvia, and University Hospital Düsseldorf in Düsseldorf, Germany. The study population consisted of patients with asymptomatic AAAs who underwent elective treatment between January 2014 and June 2017. Follow-up CT scans were performed at one month, six months, one, two, and three years after implantation. Changes in stent graft length, aneurysm sac diameter, and the proximal and distal sealing zones were evaluated. Results: A retrospective analysis was conducted on computed tomography (CT) images from 40 patients (mean age 70.4 ± 8.5 years, 34 males, 6 females) who were treated with the ALTURA™ stent graft system for infrarenal abdominal aortic aneurysms (mean aneurysm diameter 5.6 ± 1.0 cm). The mean follow-up duration was 24.2 ± 10.6 months, with CT scans completed for all patients at one month and for 80% at one year. The mean total shortening of the stent graft one year after EVAR was 4 ± 3 mm (p < 0.001), 7 ± 5 mm after two years (p < 0.001), and 9 ± 6 mm after three years (p < 0.001). The iliac extensions shortened by 4 ± 3 mm after one year (p < 0.001), 6 ± 4 mm after two years (p < 0.001), and 8 ± 4 mm after three years (p < 0.001). Significant shortening was observed in the iliac extension, while changes in the aortic stent graft were not statistically significant. The reduction in the distal sealing zone and upward migration of the stent graft were 3 ± 3 mm after one year (p < 0.001), 5 ± 5 mm after two years (p < 0.001), and 7 ± 7 mm after three years (p < 0.001). Over the follow-up period, significant stent graft shortening and loss of the distal sealing zone were observed. However, these changes remained within a clinically acceptable range and did not lead to type I endoleak. Aneurysm sac shrinkage greater than 10 mm one year after treatment was observed in 25% of patients (p < 0.001). No aneurysm ruptures or AAA-related deaths were reported. Conclusions: Significant shortening of ALTURA™ stent graft, migration, and sealing zone reduction were observed without clinical impact after three years. However, in patients with short distal sealing zones, these changes could increase the risk of type Ib endoleak. Longer follow-up is needed to assess long-term durability.