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Objective:
To investigate the factors influencing the iliac limb migration after endovascular aneurysm repair (EVAR).

Materials and Methods:
This retrospective study included 482 patients who underwent EVAR for AAA between September 2005 and October 2021. The study group included all patients with AAA who qualified to undergo their EVAR procedure and had undergone CT-angiography before, approximately 1 week after and 3 years after EVAR. CT-angiography analysis was performed on EVAR patients selected from our registry, using a software package (TeraRecon Aquarius). Pre- and postprocedural CT images were analyzed and the iliac limb migration length was assessed. Possible predisposing factors such as aortic aneurysm diameter, aortic tortuosity index, aortic angle, common iliac artery diameter, iliac artery tortuosity index, iliac angle, iliac sealing length and iliac limb oversizing degree were measured. Manufacturers of iliac limb, use of bell-bottom stent-graft, and presence of endoleak were also reviewed. Correlations between the iliac limb migration length and possible predisposing factors were evaluated using multivariate logistic regression analysis.

Results:
A total of 224 iliac limbs meeting the inclusion criteria were identified in 112 patients. Significant relationships between several factors (aortic tortuosity index, aortic angle, iliac angle, iliac sealing length, and presence of endoleak) and significant iliac limb migration (> 5-mm) were found.

Conclusion:
Migration of the iliac limb after EVAR was influenced by several factors including aortic tortuosity index, aortic angle, iliac angle, iliac sealing length, and presence of endoleak. Patients with these factors require more vigorous surveillance after EVAR.