Outcomes of endosutured aneurysm repair with the Heli-FX EndoAnchor implants

Abstract

Objective Endovascular aneurysm repair has gained field over open surgery for the treatment of abdominal aortic aneurysm. However, type Ia endoleak represents a common complication especially in hostile neck anatomy that is recently faced using endoanchors. We conducted a systematic review and meta-analysis to collect and analyse all the available comparative evidence on the outcomes of the endosuture aneurysm repair in patients with or without hostile neck in standard endovascular aneurysm repair. Methods The current meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All the prospective and retrospective studies reporting primary use of the Heli-FX EndoAnchor implants were considered eligible for inclusion in this study. The main study outcomes (technical success of endoanchor implantation, incidence of type Ia endoleak, aortic stent graft migration and the percentage of patients who presented regression or expansion of aneurysm sac throughout the follow-up) were subsequently expressed as proportions and 95% confidence intervals. Results Eight studies with a total of 968 patients were included in a pooled analysis. The technical success of the primary endoanchor fixation was 97.12% (95%CI: 92.98–99.67). During a mean six months follow-up period, a pooled rate of 6.23% (95%CI: 0.83–15.25) of the patients developed a persistent type Ia endoleak despite the primary implantation. Migration of the main graft was reported in five studies, in which a 0.26% (95%CI = 0.00–1.54) of the patients required an additional proximal aortic cuff. Regression of the aneurysm sac was observed at 68.82% (95%CI: 51.02–84.21). An expansion of the aneurysm sac was found in 1.93% (95%CI: 0.91–3.24) of the participants. The overall survival rate was 93.43% (95%CI: 89.97–96.29) at a mean six months follow-up period. Conclusions Endosuture aneurysm repair with the Heli-FX EndoAnchor implants seems to be technically feasible and safe either for prevention or for repair of intraoperative type Ia endoleak. Despite the primary implants of endoanchors, few cases of persistent type Ia endoleak and migration are still conspicuous. Long-term follow up is needed to determinate the role of this therapeutic option in the treatment of aortic aneurysms.

Technological Advances to Address the Challenging Abdominal Aortic Aneurysm Neck

“…Aneurysm sac regression has also been shown to be significantly higher in patients treated with EndoAnchors than those without [ 19 ]. Complications of EndoAnchors are rare and primarily limited to maldeployment; however, meta-analysis have demonstrated technical success rates as high as 97% [ 20 ]. Relative contraindications for Heli-FX EndoAnchors include infrarenal neck length 8 mm, neck diameter 34 mm, neck angulation 90°, circumferential neck calcification, and circumferential aortic mural pathology 2 mm in thickness [ 21 ].…”

Điều trị thành công biến chứng endoleak type IA sau can thiệp đặt stent graft phình động mạch chủ bụng bằng dụng cụ cố định Heli-FX

“…Kết quả sau khoảng 1 năm cho thấy ở nhóm can thiệp thì đầu 95% không có endoleak type I và 77% ở nhóm can thiệp thì hai, phình mạch được lấp đầy trên 5mm ở nhóm can thiệp thì đầu là 45% và 25% ở nhóm can thiệp thì hai. Theo nghiên cứu của Rocco Giudice và cộng sự [8] [9] cho thấy tỷ lệ thành công về mặt kỹ thuật là 97,12%, biến chứng endoleak type IA là 6,23% được ghi nhận trong 5 nghiên cứu, di chuyển stent ghi nhận 0,26%, tỷ lệ không phải can thiệp thì hai là 97,68%, không có trường hợp nào vỡ phình mạch. Từ những kết quả nghiên cứu đã có cho thấy tính an toàn và hiệu quả cao trong điều trị của dụng cụ cố định stent vào mạch máu.…”

Endovascular aortic repair with EndoAnchors demonstrate good mid-term outcomes in physician-initiated multicenter analysis—The PERU registry

“…The recent metaanalysis by Qamhawi et al 13 echoed this, stating that EndoAnchor use in routine clinical practice could not be recommended without support from trial data. However, this flies in the face of the fact that such new technology has already become part of our endovascular armamentarium; 14 use of such advances get (safely) entrenched into practice with supportive data indicating that type IA endoleakage is reduced with EndoAnchor usage, 12,15 whether the desirable trials occur or not. This is exemplified by the uptake of fenestrated endovascular aneurysm repair (FEVAR) and chimney EVAR.…”