One-year results of the ANCHOR trial of EndoAnchors for the prevention and treatment of aortic neck complications after endovascular aneurysm repair

Jordan, William D.; Mehta, Manish; Ouriel, Kenneth; Arko, Frank R.; Varnagy, David; Joye, James D.; Moore, William M.; Vries, Jean‐Paul P.M. de

doi:10.1177/1708538115590727

Cited by 44 publications

(32 citation statements)

References 32 publications

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“…They found that freedom from type 1a endoleak was 95% in the primary arm and 77% in the revisions. Hostile necks were defined as those with a neck length of <10 mm, neck diameter >28 mm, or angulation >60°, or those with a conical configuration or significant mural thrombus or calcifications . Our experience extends the use of the EndoAnchors to shorter proximal aortic necks and further demonstrates the functionality of EndoAnchors in promoting proximal fixation.…”

Section: Discussionmentioning

confidence: 88%

Preliminary results of adjunctive use of endoanchors in the treatment of short neck and pararenal abdominal aortic aneurysms

Galiñanes

Hernández

Krajcer

2015

Cathet Cardio Intervent

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Section: Discussionmentioning

confidence: 88%

Preliminary results of adjunctive use of endoanchors in the treatment of short neck and pararenal abdominal aortic aneurysms

Galiñanes

Hernández

Krajcer

2015

Cathet Cardio Intervent

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“…Moreover, EndoAnchor implants can increase aortic wall apposition and prevent migration during follow-up. 2,8,9 However, it is important to use the EndoAnchor implants in the same way as one would use a pledgeted suture (endovascular stitching). Thus, where sutures are used in case of a bleeding anastomosis, EndoAnchor implants can be used to resolve a type IA endoleak.…”

Section: Discussionmentioning

confidence: 99%

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

Goudeketting

Noort

Vermeulen

et al. 2019

Journal of Vascular Surgery

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Objective: The aim of this study was to analyze the penetration depth, angles, distribution, and location of deployment of individual EndoAnchor (Medtronic Vascular, Santa Rosa, Calif) implants. Methods: Eighty-six primary and revision arm patients (procedural success, 53; persistent type IA endoleak, 33) treated for type IA endoleaks with a total of 580 EndoAnchor implants from a subset of the Aneurysm Treatment Using the Heli-FX Aortic Securement System Global Registry (ANCHOR) were included in this study. Procedural success was defined as the absence of a type IA endoleak on the first postprocedural computed tomography scan after the EndoAnchor implantation procedure. Endograft malapposition along the circumference was assessed at the first postoperative computed tomography scans and expressed as clock-face range and width in degrees and normalized such that the center was translated to 0 degrees. The position and penetration of each EndoAnchor implant were measured as the clock-face orientation. EndoAnchor implant penetration into the aortic wall was categorized as follows: good penetration, $2 mm; borderline penetration, <2 mm or $2-mm gap between the endograft and aortic wall; or no penetration. The orthogonal and longitudinal angles between the EndoAnchor implant and the interface plane of the aortic wall were determined. Location of deployment was investigated for each EndoAnchor implant and classified as maldeployed when it was above the fabric or in a gap >2 mm between the endograft and aortic wall due to >2-mm thrombus or positioning of the EndoAnchor implant below the aortic neck. Results: A total of 170 (29%) EndoAnchor implants had maldeployment and were therefore beyond recommended use and not useful. After EndoAnchor implantation, the procedural success and persistent type IA endoleak groups had 3 (1%) and 4 (2%) EndoAnchor implants positioned above the fabric as well as 60 (18%) and 103 (42%) placed in a gap >2 mm, respectively. The amount of EndoAnchor implants with good, borderline, and no penetration was significantly different between both groups (success vs type IA endoleak) after exclusion of maldeployed EndoAnchor implants (235 [87.4%], 14 [5.2%], and 20 [7.4%] vs 97 [68.8%], 18 [12.8%], and 26 [18.4%], respectively; P < .001). Good penetration EndoAnchor implants were more closely aligned with a 90-degree orthogonal angle than the borderline penetration and nonpenetrating EndoAnchor implants. The longitudinal angle was more distributed, which was observed through all three penetration groups. Conclusions: In this subcohort of ANCHOR patients, almost 30% of the EndoAnchor implants had maldeployment, which may be prevented by careful preoperative planning and measured intraoperative deployment. If endoleaks are due to >2-mm gaps, EndoAnchor implants alone may not provide the intended sealing, and additional devices should be considered.

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“…On the other hand, in patients unfit for open surgery and with short proximal neck (<15 mm in length) that is at least 7 mm long and up to 32 mm in diameter, our standard practice is to prefer the use of the Endurant stent-graft with the eventual adjunct of anchors, considering the relative simplicity of the procedure, the immediate availability of devices, and the satisfactory reported early- and mid-term results in terms of aneurysm exclusion and stability. 15,16,20,21 For those cases with a proximal neck shorter than 7 mm and/or wider than 32 mm that are not eligible for open surgery, there is the need to extend the proximal sealing zone above the renal arteries to prevent late complications in the follow-up, so we prefer to resort to other endoluminal techniques such as fenestrated stent-grafts, or chimney procedures when there is no possibility to wait for a custom-made device.…”

Section: Discussionmentioning

confidence: 99%

The use of EndoAnchors in endovascular repair of abdominal aortic aneurysms with challenging proximal neck: Single-centre experience

Giudice

Borghese

Sbenaglia

et al. 2019

JRSM Cardiovascular Disease

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Objectives The aim of this study was to present a single-centre experience with EndoAnchors in patients who underwent endovascular repair for abdominal aortic aneurysms with challenging proximal neck, both in the prevention and treatment of endograft migration and type Ia endoleaks. Methods We retrospectively analysed 17 consecutive patients treated with EndoAnchors between June 2015 and May 2018 at our institution. EndoAnchors were applied during the initial endovascular aneurysm repair procedure (primary implant) to prevent proximal neck complications in difficult anatomies (nine patients), and in the follow-up after aneurysm exclusion (secondary implant) to correct type Ia endoleak and/or stent-graft migration (eight patients). Results Mean time for anchors implant was 23 min (range 12–41), with a mean of 5 EndoAnchors deployed per patient. Six patients in the secondary implant group required a proximal cuff due to stent-graft migration ≥10 mm. Technical success was achieved in all cases, with no complications related to deployment of the anchors. At a median follow-up of 13 months (range 4–39, interquartile range 9–20), there were no aneurysm-related deaths or aneurysm ruptures, and all patients were free from reinterventions. CT-scan surveillance showed no evidence of type Ia endoleak, anchors dislodgement or stent-graft migration, with a mean reduction of aneurysm diameter of 0.4 mm (range 0–19); there was no sac growth or aortic neck enlargement in any case. Conclusions EndoAnchors can be safely used in the prevention and treatment of type Ia endoleaks in patients with challenging aortic necks, with good results in terms of sac exclusion and diameter reduction in the mid-term follow-up.

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One-year results of the ANCHOR trial of EndoAnchors for the prevention and treatment of aortic neck complications after endovascular aneurysm repair

Abstract: Despite a high frequency of hostile neck anatomy, proximal neck complications were relatively infrequent after EndoAnchor use.

Cited by 44 publications

References 32 publications

Preliminary results of adjunctive use of endoanchors in the treatment of short neck and pararenal abdominal aortic aneurysms

Preliminary results of adjunctive use of endoanchors in the treatment of short neck and pararenal abdominal aortic aneurysms

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

The use of EndoAnchors in endovascular repair of abdominal aortic aneurysms with challenging proximal neck: Single-centre experience

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