Influence of aortic neck characteristics on successful aortic wall penetration of EndoAnchors in therapeutic use during endovascular aneurysm repair

Abstract

Adequate EndoAnchor penetration into the aortic wall is less likely when the aortic neck diameter is large or when the neck contains significant mural calcium. No penetration of the EndoAnchor was the only factor predictive of postprocedural type IA endoleak. This study stresses the importance of careful selection of patients based on preoperative assessment of the infrarenal neck on CT angiography and emphasizes careful deployment of EndoAnchors into the aortic wall to improve successful treatment of type IA endoleaks.

Analysis of the position of EndoAnchor implants in therapeutic use during endovascular aneurysm repair

“…If EndoAnchor implants are correctly deployed and positioned, they can be successfully used to treat type IA endoleaks and, especially in case of small gutters, will be effective. 5 This effectiveness is related to the amount of pressure that can be applied with the guide to push the endograft to the aortic wall. Importantly, the EndoAnchor implants will work sufficiently only when the endograft is pushed toward the aortic wall by the force of the applier.…”

“…The circumference over which there was endograft malapposition was expressed as the clock-face range and width in degrees (Fig 1, A), normalized such that the center was translated to 0 degrees (Fig 1, B). 5 EndoAnchor implant penetration.…”

“…EndoAnchor implant penetration measurements were performed on the first postprocedural CT scan after EndoAnchor implant deployment. In a previous publication, 5 penetration of the EndoAnchor implants was reviewed as good penetration when the EndoAnchor implant penetrated the aortic wall $2 mm, borderline penetration because of <2 mm of penetration or a gap between the endograft and aortic wall, or no penetration when there was no penetration into the aortic wall. Two experienced observers (S.G., K.N.)…”

“…However, this strength can be achieved only if the EndoAnchor implants successfully penetrate the aortic wall at least 2 mm. [3][4][5] A recent publication demonstrated the association between aortic neck characteristics and successful EndoAnchor penetration in patients with type IA endoleaks. The aortic neck diameter and neck calcium thickness were independent predictors for individual EndoAnchor implant maldeployment.…”

“…Moreover, a larger number of nonpenetrating EndoAnchor implants were associated with an increased risk for type IA endoleaks. 5 However, the reasons for failed EndoAnchor implant penetration in the aortic wall were not investigated. Technical errors affect successful penetration, including placement of EndoAnchor implants above the fabric, deployment at a tangential angle to the aortic wall, and placement at the site of a large gap between the aortic wall and endograft.…”