Predictors of inadequate EndoAnchors aortic wall penetration for the Endosutured therapy in hostile neck patients

Valdivia, Andrés Reyes; Santos, África Duque; Pitoulias, Georgios A.; Sanus, E. Aracil; Guaita, Julia Ocaña; Zúñiga, Claudio Gandarias

doi:10.23736/s0021-9509.20.11248-5

Cited by 2 publications

(2 citation statements)

References 20 publications

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“…Our rate of EA maldeployment was 7%, which compares favorably with both our EA maldeployment rate in GA-ESAR and with those of recent detailed analyses of inadequate aortic wall penetration, which reported rates ranging from 17% to 26% [ 16 , 17 ]. We believe that LA-ESAR can only be said to be successful if EAs are deployed appropriately for function.…”

Section: Discussionsupporting

confidence: 86%

Anesthetic, Sedation, and Analgesic Technique for Successful Local Anesthetic EndoSuture Aneurysm Repair

Hennessy

Hussey

2023

Vasc Specialist Int

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Purpose We aimed to describe our technique for and experience with elective endovascular aneurysm repair using EndoAnchors under local anesthesia. Materials and Methods We included seven patients with abdominal aortic aneurysms who underwent endovascular aneurysm repair using EndoAnchors with a standard regimen consisting of local anesthesia, intravenous sedation, and analgesia. The procedural and follow-up details were retrospectively reviewed. Results Six out of seven infrarenal abdominal aortic aneurysms were successfully treated with endovascular aneurysm repair using primary EndoAnchors under local anesthesia. One patient was converted to general anesthesia due to acute aneurysm thrombosis independent of EndoAnchor deployment during the procedure. Remifentanyl infusions of up to 3.2 mg/min, morphine doses up to 6 mg (median, 0.5 mg), and midazolam doses of up to 4 mg (mean, 1.4 mg) were used. The mean theater time was 83 minutes (range, 60–130 minutes). Two patients were discharged on day 0, and the mean hospital stay was one day. All patients were alive between 484 and 1,128 days post-procedure, with no aneurysm-specific reintervention. Conclusion The combination of local anesthesia, intravenous sedation, and analgesia is a viable strategy for timely and effective endovascular aneurysm repair using EndoAnchors. This technique may allow endovascular repair of more ruptured aneurysms using EndoAnchors with potential survival benefits.

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Section: Discussionsupporting

confidence: 86%

Anesthetic, Sedation, and Analgesic Technique for Successful Local Anesthetic EndoSuture Aneurysm Repair

Hennessy

Hussey

2023

Vasc Specialist Int

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“…These approaches are critical to optimising the length of the LZ in order to minimise the risk of type I endoleaks (T1ELs). 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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Predictors of inadequate EndoAnchors aortic wall penetration for the Endosutured therapy in hostile neck patients

Cited by 2 publications

References 20 publications

Anesthetic, Sedation, and Analgesic Technique for Successful Local Anesthetic EndoSuture Aneurysm Repair

Anesthetic, Sedation, and Analgesic Technique for Successful Local Anesthetic EndoSuture Aneurysm Repair

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

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