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This is a Literature Review study (also classified as: Observational).

August 21, 2025Open Access

Geometric Aortic Remodeling and Stent-Graft Migration After TEVAR: Insights from Longitudinal 3D Analysis and Literature Review

Key Points

Progressive geometric remodeling after TEVAR is linked to higher migration rates and complications such as endoleaks, raising concerns for patient safety and management.
The 3D analysis revealed undetectable early changes in aortic geometry that correlate with increased stent-graft migration risks, emphasizing the inadequacy of traditional imaging.
A focused literature review reinforces the clinical significance of monitoring stent-graft migration, given its association with high rates of reintervention and morbidity over time.
Personalized geometric surveillance following TEVAR is crucial for optimizing patient outcomes, potentially preventing severe complications like rupture through advanced tools.

Abstract

Background: Long-term follow-up after endovascular aortic repair (TEVAR) is crucial to detect adverse aortic remodeling, even with modern stent grafts offering enhanced flexibility and durability. Conventional imaging, based on diameter measurements, may fail to identify complications such as endograft migration. Methods: We conducted a longitudinal 3D geometric analysis of thoracic aortic and stent-graft evolution over 10 years in a patient treated for descending thoracic aortic aneurysm (DTAA) by endovascular treatment. A three-dimensional morphological analysis (length, tortuosity, angulation, and diameter) was carried out using advanced imaging software (EndoSize, MATLAB) to track aortic geometry and stent-graft behavior over time. A focused review of the literature on stent-graft migration, its risk factors, complications, and surveillance strategies was also performed. Results: This case illustrates how progressive geometric remodeling—including aortic elongation and increased tortuosity—can lead to delayed stent-graft migration and late type III endoleaks, with an elevated risk of rupture. The 3D analysis revealed early morphological changes that were undetectable using standard diameter-based follow-up. These observations are consistent with published data showing higher migration rates over time, particularly in tortuous anatomies. The literature review further emphasizes the clinical relevance of geometric surveillance, given the high rates of reintervention, morbidity, and mortality associated with stent-graft migration. Conclusions: This study underlines the importance of personalized and geometry-based surveillance after TEVAR. Advanced morphological assessment tools provide valuable insights for the early detection of complications and tailored patient management. Their integration into routine follow-up could help optimize long-term outcomes and prevent life-threatening events such as rupture.

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