The AFX endovascular graft system stands out as a beacon of innovation in the fight against abdominal aortic aneurysms (AAAs), conditions characterized by a dangerous expansion of the aorta. Designed to adapt to the body’s vascular pathways, especially for those with challenging narrow aortic bifurcations, the AFX brought new hope to patients and physicians alike. However, its path has been navigated with caution, following advisories from the Food and Drug Administration since 2017, which highlighted concerns over potential complications. This narrative delves into the intricate dance between pioneering medical technology and the imperative for safety, shedding light on the nuanced decisions that drive medical advancements forward.
Through a landmark study led by Dr. Katsuhiko Oda from Iwate Prefectural Central Hospital, along with colleagues Dr. Makoto Takahashi, Dr. Naoya Terao, Dr. Rina Akanuma, Dr. Takahiko Hasegawa, and Dr. Satoshi Kawatsu, the long-term efficacy of the AFX endograft in treating abdominal aortic aneurysms (AAAs) was meticulously evaluated. Published in the Journal of Vascular Surgery Cases, Innovations and Techniques, this research provides a deep dive into the unique challenges and concerns surrounding the AFX endograft, celebrated for its unibody design optimized for narrow aortic bifurcations but scrutinized for potential efficacy issues over time.
Dr. Oda shared insights from their research, highlighting, “We encountered two fusiform abdominal aortic aneurysm cases with delayed AFX endograft migration more than four years after placement. These cases showed shortening and slight angulation of the main body in the anteroposterior direction.” The research team speculated on the AFX endograft’s propensity for shortening at its bifurcation point, which could contribute to delayed migration, underlining the critical importance of comprehensive preoperative planning.
The team’s research observed several instances of AFX endograft usage for AAAs. “A small fraction of the fusiform AAAs experienced delayed migration. We found that the slight angulation of the main body in the anteroposterior direction in fusiform AAAs is important for delayed migration,” Dr. Oda explained, emphasizing the anatomical considerations crucial in device selection and patient outcomes.
Further examination of the AFX stent structure revealed its tendency for the lower part of its main body to shorten, a characteristic that significantly influences the observed delayed migrations. “The lower part of the main body could easily shorten… We speculate that this portion might have played a pivotal role in the shortening of the main body of the AFX as observed in our migration cases,” noted Dr. Oda, stressing the interplay between the device’s design and the patient’s anatomy. Concluding their investigation, Dr. Oda and his team recommended cautious use of the AFX endograft, particularly in cases where preoperative assessment predicts anteroposterior angulation of the device’s main body. This study contributes valuable insights into the clinical performance of the AFX endograft and underlines the importance of personalized treatment planning in vascular surgery.
JOURNAL REFERENCE
Katsuhiko Oda, Makoto Takahashi, Naoya Terao, Rina Akanuma, Takahiko Hasegawa, and Satoshi Kawatsu, “Delayed migration due to shortening of the lower part of AFX endograft’s main body in angled fusiform abdominal aortic aneurysm,” Journal of Vascular Surgery Cases, Innovations and Techniques, 2023.
DOI: https://doi.org/10.1016/j.jvscit.2023.101311
ABOUT THE AUTHOR
Dr. Katsuhiko Oda is the Chief Director of the Departments of Cardiovascular Surgery, Cardiovascular Center, and Medical Safety at Iwate Prefectural Central Hospital, Morioka, Japan, and Clinical Professor (Cardiovascular Surgery) at the Tohoku University School of Medicine, Sendai, Japan.
Dr. Oda was born in Morioka, Japan, in 1966. In 1985, he graduated from Morioka First High School at the top of his class, after which he enrolled at the Tohoku University School of Medicine in the same year. In 1990, he won the All-Japan Lightweight Rowing Championship (Men’s Eight) as the No. 7 rower of Tohoku University Varsity Eight. He graduated from the Tohoku University School of Medicine and passed the Examination of the National Board in 1991. He obtained his doctorate from the Tohoku University Graduate School of Medicine in 1998. He later became a Board-Certified Cardiovascular Surgeon in 2004 and a Board-Certified Instructing Doctor of Cardiovascular Surgery in 2005. His academic interests include coronary artery bypass grafting, acute aortic dissection (particularly the aortic hiatus), thoracic endovascular aortic repair (TEVAR), endovascular aortic repair (EVAR), transcatheter aortic valve implantation (TAVI), implantable ventricular assist device (VAD), and patient safety.
He is currently married and has two daughters. His English proficiency skill is CEFR-B2 and CSE score 2491 (March 2023). He is passionate about muscle training, watching Formula 1 Grand Prix races, and following matches played by the masters of Shogi, the Japanese chess. Additionally, he has been an avid reader of Sherlock Holmes, the renowned detective, since his junior high school years and enjoys listening to Simply Red, the rock group from Manchester.
