EndoAnchors in Thoracic, Thoracoabdominal, and Complex Abdominal Endovascular Aortic Repairs: Safe and Effective

Ongstad, Sarah; Ou, Christine; Panneton, Jean M.

doi:10.1016/j.jvs.2017.07.014

Cited by 4 publications

(6 citation statements)

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“…Once a decision is made to intervene, management of endoleaks varies by type. Type I endoleaks are best handled by extending the proximal and distal portions of the stent graft to include non-diseased portions of the aorta and by using endoanchors, which securely fasten edges [ 8 ]. However, the extension of the proximal or distal edges of grafted stents requires consideration of the risk associated with coverage of the left subclavian artery, left carotid artery, or spinal segmental arteries.…”

Section: Discussionmentioning

confidence: 99%

Evaluation and Management of Complications of Endovascular Aneurysm Repair of the Thoracic Aorta

Bordes¹,

Vefali²,

Montorfano³

et al. 2023

Cureus

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Thoracic endovascular aortic repair (TEVAR) has become the standard of care for descending thoracic aortic pathology as the procedure has a historically low rate of reintervention and a high rate of success. However, TEVAR can be associated with complications such as endoleak, upper extremity limb ischemia, cerebrovascular ischemia, spinal cord ischemia, and post-implantation syndrome.An 80-year-old man with a history of complex thoracic aortic aneurysms underwent repair of a large thoracic aneurysm with a frozen elephant trunk procedure in 2019 at an outside institution. The proximal aortic graft extended to the arch and the innominate and left carotid artery were implanted into the distal portion of the graft. The endograft, extending from the proximal graft to the descending thoracic aorta, was fenestrated to maintain left subclavian artery flow. In an attempt to gain a seal at the fenestration, a Viabahn graft (Gore, Flagstaff, AZ, USA) was inserted. A type III endoleak was identified postoperatively at the fenestration, and a second Viabahn graft was required to gain a seal during the initial hospitalization. In 2020, an endoleak persisted at the fenestration on follow-up imaging, but the aneurysmal sac was stable. No intervention was recommended. The patient later presented to our institution with three days of chest pain. A type III endoleak at the level of the subclavian fenestration persisted with significant enlargement of the aneurysm sac. The patient underwent an urgent repair of the endoleak. This consisted of covering the fenestration with an endograft and left carotid to subclavian bypass. Subsequently, the patient developed a transient ischemic attack (TIA) due to kinking and extrinsic compression by the large aneurysm sac of the proximal left common carotid artery, requiring a right carotid to left carotid-axillary graft bypass.This report with a literature review discusses TEVAR complications and outlines methods to approach them. TEVAR complications and their management should be firmly understood to improve overall treatment outcomes.

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Section: Discussionmentioning

confidence: 99%

Evaluation and Management of Complications of Endovascular Aneurysm Repair of the Thoracic Aorta

Bordes¹,

Vefali²,

Montorfano³

et al. 2023

Cureus

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“…Ho et al 28 report on six patients a total of 50 EndoAnchors with a mean 8.3 per patient and technical success of 83.3% due to one loss. The largest series up to date has been described by Ongstaad et al 19 reporting on 54 TEVAR patients with a total of 508 EndoAnchors and a mean of 9.4 per patient achieving a technical success of 99.8%; however, no AWP data was reported nor their follow-up outcomes. Also, DuBois et al 29 report on the use of EndoAnchors in six patients with hostile distal landing zones, where they might improve fixation and prolong the more complex distal repair, such as the use of branched devices, with the increased risk of paraplegia and other visceral complications.…”

Section: Discussionmentioning

confidence: 99%

“…EndoAnchors (EAs; Heli-FX EndoAnchor System, Medtronic Inc, Minneapolis, USA) use has been largely described mainly in the abdominal sector, 14,15 where an effect in improving endograft fixation is directly related to adequate aortic wall penetration by each ‘screw’, 16 as some studies evaluating the maximal strength of the use of EndoAnchors is achieved when a circumferential apposition around the endograft is obtained. 17 Therefore, this rationale is extrapolated into the TEVAR procedures where it is supposed to work as an adjunct to improve proximal and distal fixation, and to both prevent and treat T1EL 18,19 ; however, these descriptions in the thoracic sector are scarce and based on early experiences or case reports.…”

Section: Introductionmentioning

confidence: 99%

Mid-term outcomes of the use of endoanchors during thoracic endovascular aortic repair in multicentre analysis

et al. 2022

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Objective To describe mid-term outcomes of the use of EndoAnchors as an adjunct for arch and thoracic endovascular aortic repair (TEVAR). Methods A retrospective multicentre series from nine centres using the Heli-FX EndoAnchor System (Medtronic Inc, Minneapolis, USA) at TEVAR over May 2014–May 2019 is presented. The study is registered at ClinicalTrials.gov with number NCT04100499. The primary outcome was freedom from Type I endoleak at EndoAnchors deployments; secondary outcomes included evaluation of aortic wall penetration (AWP) at first computed tomography scan, EndoAnchor-related issues and mortality. Results 54 high-risk patients (35 males/19 females, age 73 ± 11 years) with arch, thoracic and thoracoabdominal aneurysmal disease (3 chronic post-dissection and one patch pseudoaneurysm), with a mean neck length 19.7 ± 6.6 mm that were treated with multiple hybrid and endovascular techniques were included. A total of 329 EndoAnchors were used with a mean of 6.1 ± 2.5 per patient. Overall adequate AWP was 86%, whereas arch (Ishimaru’s zones 0–2) deployments achieved 80.6% when compared to 87.3% in descending thoracic aorta (dTA); although there was no statistical significance. Freedom from type I endoleaks was 88% at 2 year follow-up, due to 4 type IA endoleaks, two of them successfully treated, one with conservative treatment due to complexity of repair and remaining patient died 1 year later due to endograft infection. There were reported five EndoAnchor-related issues; four losses and one renal stent-graft was crushed due to catheter deflection solved with balloon reinflation. None of the losses had clinical significance. Overall mortality is described for 7 (9.5%) patients, one of them aneurysm-related. Conclusions The adjunctive use of EndoAnchors in TEVAR and complex TEVAR procedures achieved acceptable outcomes at midterm in a high-risk series with hostile seal zones. Still, they should be still judiciously used as there is lack of data to suggest a more liberal use; therefore, the landing zone should not be compromised in favour of their use.

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Section: Treatmentmentioning

confidence: 99%

“…While long-term data for EndoAnchors is lacking, a recent study found a reintervention rate of 13.5% in patients with prophylactic EndoAnchors compared to 23.5% who received EndoAnchors as a therapeutic placement. 24,28 Physicians should consider fEVAR, bEVAR, or snorkel, periscope, or sandwich chimney grafting in cases when coverage of the celiac artery is not suitable, with <2 cm above the celiac artery is available for a distal seal or in cases of aortic degeneration. While long-term outcome studies are not available for these techniques, their methodology has been well described.…”

Section: Treatmentmentioning

confidence: 99%

How to treat type 1b endoleakage-extension, fEVAR, bEVAR, or open repair

Khouqeer

Etheridge

Coselli

et al. 2022

Asian Cardiovasc Thorac Ann

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Thoracic endovascular aneurysm repair has been well described in the literature as a treatment for a wide range of thoracic aortic pathologies. As with any intervention, there remains a risk of an unfavorable outcome, including endoleak, a term used to describe unexpected blood flow between the stent-graft and the wall of the excluded aneurysm. Endoleaks cause pressurized enlargement of the aneurysmal sac and may lead to catastrophic outcomes such as rupture and death. Type 1b endoleak represents a distal landing zone that is compromised by retrograde blood flow. Moreover, there is a lack of data on type 1b endoleaks and its management options. With the increase in emerging endovascular techniques and technologies, endoleaks are more frequent. However, the management of endoleaks is not standardized among different centers. The purpose of this article is to provide an overview of type 1b endoleaks after thoracic endovascular aneurysm repair, current management options, and our experience.

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EndoAnchors in Thoracic, Thoracoabdominal, and Complex Abdominal Endovascular Aortic Repairs: Safe and Effective

Cited by 4 publications

References 0 publications

Evaluation and Management of Complications of Endovascular Aneurysm Repair of the Thoracic Aorta

Evaluation and Management of Complications of Endovascular Aneurysm Repair of the Thoracic Aorta

Mid-term outcomes of the use of endoanchors during thoracic endovascular aortic repair in multicentre analysis

How to treat type 1b endoleakage-extension, fEVAR, bEVAR, or open repair

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